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I........................................................................................... S/o.......................................................
Resident of......................................................................................................................................
Do hereby solemnly affirms and declare as under:
Deponent
Verification:
Verified A t ................................... On t h i s .......................................... day of ..............................
Month and year 20 __, that I, the above named deponent verify the content of this affidavit to be
true to the best of my knowledge and belief and nothing material has been concealed.
Deponent
Date:
Place: