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AFFIDAVIT

1. The affidavit provides details of an individual applying for enrolment under the Agnipath scheme, including his caste, permanent home address, places of residence in the last five years, marital status, and court cases if any. 2. The applicant acknowledges that he can only attend one recruitment rally per recruiting year (April-March) based on his domicile certificate to avoid duplication. 3. He provides information on the nativity/domicile certificate issued to him by the Zonal Deputy Tahsildar, including the details and validity. He undertakes that all documents submitted are correct.

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64 views4 pages

AFFIDAVIT

1. The affidavit provides details of an individual applying for enrolment under the Agnipath scheme, including his caste, permanent home address, places of residence in the last five years, marital status, and court cases if any. 2. The applicant acknowledges that he can only attend one recruitment rally per recruiting year (April-March) based on his domicile certificate to avoid duplication. 3. He provides information on the nativity/domicile certificate issued to him by the Zonal Deputy Tahsildar, including the details and validity. He undertakes that all documents submitted are correct.

Uploaded by

ayyan communication
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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AFFIDAVIT

ENROLMENT OF AGNIVEERS UNDER AGNIPATH SCHEME

1. I, Name Narsimman R son of Raja while applying for enrolment as Agniveer


in Army solemnly affirm & state the following in my respect.
a) I belong to the following Caste MBC SubCaste Vanniar Religion:Hindu
b) My Residential Addresses are as Under :-

I. Permanent Home Address


Fathers Name RAJA House no. 4/877 Vill/Mohalla PUKKAN VATTAM,
MELMAMUDIMANAPALLI po PATCHUR Tehsil TIRUPATTUR Dist.
TIRUPATTUR State TAMILNADU, Pin code: 635 854.
-2-
II. Permanent Home Address
Fathers Name RAJA House no. 4/877 Vill/Mohalla PUKKAN VATTAM,
MELMAMUDIMANAPALLI po PATCHUR Tehsil TIRUPATTUR Dist.
TIRUPATTUR State TAMILNADU, Pin code: 635 854.
III. I fully understand that if enrolled, a detailed verification of my character and
antecedents will be carried out by police and civil administration from my
permanent address submitted above and also places where I have resided in the
last five years.

IV. My places of residence in the last five years are as stated under :-

Residential address in full i.e., House


S/No From To Number, Lane/Street/Road,
Village/Town/Mohall, Thana, Post,
Office, Tehsil and District
No. 4/877
1. 05.06.2003 TILL DATE Vill/Mohalla PUKKAN VATTAM
MELMAMUDIMANAPALLI
Po PATCHUR
Tehsil TIRUPATTUR
Dist. TIRUPATTUR
State TAMILNADU

c) I am Unmarried.
d) I hereby certify that I am not involved in any civil / criminal case
(OR)
I was involved in following cases but was acquitted:-

I. - NIL -_________
II. - NIL -_________
(OR)
Following court cases / FIR are pending against me:-

I. - NIL -_________
II. - NIL -_________

e) I have not participated in any violent / arson / destruction of


Government property.
-3-

f) Consent Certificate I am below 18 years and my parents give their


consent, for attending the Army Recruitment Rally. ( if applicable )

Signature of Father_____________________

g) I am authorized to attend UHQ rally because I am son/brother of


No______________Name____________Regt____________
h) I hereby certify that I, son of
No___________________Name____________
Regt ______________________am eligible for claiming bonus marks as
none of my brothers have been enrolled in Army earlier / I am not eligible
to claim bonus marks (cut whichever is not applicable).

2. I am aware that there is only one recruitment rally conducted in a recruiting year
(01 April to 31 March) for every district and therefore I am entitled to attend only
once every recruiting year from my home town district based on my nativity /
domicile certificate. I fully understand that if I attend another recruitment rally in
the same recruiting year, based on a different district Nativity / Domicile
Certificate, my candidature will be cancelled and if enrolled, I will be dismissed
from service.

3. I am attending this recruitment rally based on the Nativity / Domicile certificate


issued by Zone Deputy Tahsildar(mention the state government ), details of
which are as stated below :-
S/No Cert No Date of Issue Validity Issuing Authority

1. TN-3202008212789 25.08.2020 One Year S.Kannan


Zonal Deputy Tahsildar
-4-

4. Details of nativity/domicile certificate held by me in past (if any) are as stated


below:-
S/No District Issued by Issuing Present status
date (Valid/Expired)
S.KANNAN
1. TIRUPATTUR ZONALDEPUTY 25.08.2020 VALID
TAHSILDAR
5. I hereby that till date I have attended the following Army Recruitment rallies:-
Recruitment Army Month Category Nativity/Domicile
S/No Rally Venue Recruitment and Applied Certificate
Office Year For Address used

a)

b)

c)

6. I give an undertaking that all documents submitted by me are correct. All


documents issued by Government organization / offices have been signed by
authorized designated / Government officials. If any document at any stage is
found fake or wrong information is furnished by me, I am aware that I will be
dismissed from service and FIR will be lodged against me.

Signature of Notary Signature of


Candidate

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