ON NON-JUDICIAL STAMP PAPER WORTH Rs.

50/-

I ________________________________ S/o / D/o Shri ___________________________

R/o
___________________________________________________________________________
______

do hereby solemnly affirm and state as under:

1. I declare that no any Criminal Case/ F.I.R is pending against me in any Police Station
in Indian Territory as on today.

2. I further declare that I have never been convicted by any Court of Law in any
Criminal proceeding and I have never been sentenced by any court of law as on
today.

Place :

Date :

Deponent

VERIFICATION
I _____________________________________________ S/o D/o

_________________________ verify that the contents of this affidavit are true to the best
of my knowledge and no part of the affidavit is false and nothing has been concealed or
misstated therein.

Place :

Date :

Deponent