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AFFIDAVIT / SELF DECLARATION

I, [Full Name], S/o / D/o [Father's Name], resident of [Address], do hereby solemnly affirm and declare as under:

1. That I am a permanent resident of the above-mentioned address.
2. That [Statement Details].
3. That the particulars stated above are true and correct to the best of my knowledge and belief.

Date:
Deponent (Signature)

[Full Name]