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Declaration

Reference Number ............................................................


I, , do hereby declare my
Residence address ................................................................................................
.................................................................................................
City & Pincode

..................................................................................................

Landmark

.................................................................................................

Mobile number

...................................................................................................

Residence phone ...................................................................................................


and I am enclosing the proof of my residence as specified (ticked) below..
List of Address Proof ( Please tick wherever it is applicable)
Ration Card
Passport
Driving
Utility

licence

Bill (Telephone,Electricity .. etc)

Bank Account statement / passbook


Voters ID
Registration documents / ownership
Lease Deed / Rent Agreement copy
Mobile post paid copy
Registration documents / ownership

Place:.

proof copy (property only)


proof copy

____________________
(Signature of declarant)

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