I _________ son/daughter/wife of _________ resident of _________ do hereby solemnly affirm and declare as under:
1. That I am a _________ of _________ and residing in _________ from ___ Years
2. That _________ is my real _________ and his/her correct date of birth / age is _________ / __ years.
3. That he/she is _________ person and his disability is _________ %.
4. That he/she is Handicapped and I am enclosing the Handicap Certificate as a documental proof for the same, Details are below:
a. Date of Registration: _________
b. Serial No.: _________
c. Certificate No.: _________
5. That my family annual income with all sources is _________ /-.
6. That he/she has not received any kind of pension any kind of pension from _________ and from any other _________ from the same.
7. That this is my true statement.
I, the above named deponent do hereby verify that the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.