Affidavit For Issuance of Delayed Birth Order

I JAKIR S/o of Sh. MOHD SAJID aged 19 years resident of HOUSE NO. 276, BLOCK-20,
TRILOK PURI, DELHI-110091 TRILOK PURI Trilok Puri Colony 13 to 36 Block Delhi 110091
India

hereby solemnly affirm and declare as under

1. That the exact and correct date of Birth of JAKIR is
20/01/1997 at HOUSE NO. 276, BLOCK-20, TRILOK PURI, DELHI-110091 Trilok Puri
Colony 13 to 36 Block Delhi 110091 India

2. That JAKIR have not obtained any Birth Certificate from any Government
agency/department in India.

3. All supporting documents are genuine and nothing has been concealed.

Deponent

VERIFICATION
I, the above name deponent do hereby verify that the contents of aforesaid affidavit are true and
correct to the best of my knowledge and belief. No Part of it is false and nothing material has
been concealed therefrom.

Verified at New Delhi on this 20 day of December 2016.

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