1. I, ____________________, S/o Sh __________________, hereby
undertake to state that I am not in possession of any RTR permits issued by WPC, MC ! IT based upon forei"n #RT$. %en&e I may be issued RTR 'i&ense based upon the resu't of RTR ()* e+amination he'd at ___________ ,ide my Ro'' -o. ______ .. If the information "i,en abo,e is found to be in&orre&t/fa'se, suitab'e pena' a&tion may be initiated a"ainst me by the /o,ernment of India. Si"ned at ______________ on ___________ Si"nature In presen&e of0 -ame0 )ddress0