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Issueance of Local Status Certificate - Declaration Form

This document is a declaration form for claiming local status in Andhra Pradesh for education and employment purposes. It requires the applicant to provide personal details like name, age, address and Aadhaar number. The applicant declares that they previously resided in Telangana but have now migrated to Andhra Pradesh and are residing at the stated address. The applicant affirms that the information provided is true and understands they may face prosecution if any details are found to be false. For minor applicants, the form also requires a declaration from the parent/guardian affirming the truth of the applicant's statements.

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4K views

Issueance of Local Status Certificate - Declaration Form

This document is a declaration form for claiming local status in Andhra Pradesh for education and employment purposes. It requires the applicant to provide personal details like name, age, address and Aadhaar number. The applicant declares that they previously resided in Telangana but have now migrated to Andhra Pradesh and are residing at the stated address. The applicant affirms that the information provided is true and understands they may face prosecution if any details are found to be false. For minor applicants, the form also requires a declaration from the parent/guardian affirming the truth of the applicant's statements.

Uploaded by

irfans09
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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FORM – II

DECLARATION
Scanned
passport size
photo with
self
attestation
I, _______________________________ S/o, D/o, w/o _________________________________ aged about
______________ years and resident of _________________________________ with Aadhaar
No.___________________________________ or any other documents as mentioned in the guidelines
__________________________________ hereby declare as follows:

I state that, I was resident of ___________________________________________________ of


___________________________________ District, State of Telangana (give full address with House No.
& PIN Code) and now, I Migrated to the state of Andhra Pradesh and at present I am
residing in House/Flat No.
____________________________(Village/Town)_______________________________of
_____________________________________District, Andhra Pradesh(give full address with PIN code)
from ______________(Date)/_________(Month)/_____________(Year) and desire to be the ‘local
candidate’ of Andhra Pradesh for Education & Employment purpose.

I am further to declare that the facts mentioned above and in Form – I are true and
correct to the best of my knowledge and belief.

I am further to state that if the information furnished in Form­I i.e., application, and
this declaration i.e., Form – II, is found to be false/incorrect, I am liable for prosecution and
for cancellation of any employment in Government / Organization or seat in any
Educational Institution/University, obtained based on the local status certificate.

SIGNATURE OF THE APPLICANT

[In case applicant is minor, parent/guardian shall also make following declaration apart
from the applicant’s declaration]

I _______________________________ F/o, M/o, G/o ________________________________ aged about


__________________ years and resident of _________________________________ hereby declare that the
above information and declaration furnished by the applicant is true and correct to the best
of my knowledge and belief. If the information and declaration furnished is found false, I
am liable for prosecution

SIGNATURE OF PARENT/GUARDIAN OF THE APPLICANT

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