I _________ son/daughter/wife of _________ resident of _________, do hereby solemnly affirm and declare as under:-
1. That I am citizen of _________.
2. That I am the Sole _________ of _________ which is situated at _________.
3. That I have No Current account/ Credit Facility in any Bank in _________ in the name of _________.
4. That it is my true statement.
Verified at _________ on this _________ day of _________, _________ that the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.