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BIRTH CERTIFICATE AFFIDAVIT

I, S/o residing at

, do hereby solemnly affirm and


state on oath as under:
i) That my Date of Birth is .
ii) That my Place of Birth is .
iii) That name of my Father is .
iv) That name of my Mother is .
v) That address of my parents at the time of my birth was

vi) That permanent address of my parents is

I, do hereby solemnly affirm that the contents of this affidavit


from Paragraphs 1(i) to 1 (vi) are true and correct to the best of my personal
knowledge and belief. I do understand that if the above affirmation is proved to be
false, I will be solely responsible for any situation arising thereafter.

Deponent Sworn Before Me

[Notary’s Seal/Sign]

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