Académique Documents
Professionnel Documents
Culture Documents
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
I do hereby solemnly affirm and verify that the contents of above application are true to the best
of my knowledge and belief and that I have concealed nothing.
I know that in the event of making a willful misrepresentation of suppression of facts, I shall be
liable to criminal prosecution.
________________________________
Or
Signature of applicant alongwith name
And relationship with deceased employee
Address:
___________________________________
____________________________________________________________________
_________________________________________________________________________________
_________________________________
_________________________________
b)
5. I)
II)
________________________________
Scale of pay.
________________________________
________________________________
I certain and attest the details furnished above from the record in the office and .
I)-
Recommend
II)-
CERTIFICATE
Countersignature
Signature of Applicant
CERTIFICATE
Countersignature
CERTIFICATE
Countersignature
CERTIFICATE
Countersignature
AFFIDAVIT
I do hereby solemnly affirm that, I did not avail the facility of Marriage
Grant before this. In the event of making miss-representation of facts, I shall be liable to
original prosecution.
Mr.___________________________________S/o_____________________________________
working as ____________________________________________________________________
Sr No
Name
Relationship
Age
Marital Status