AFFIDAVIT BY AGENT

Before : The Governor of Uttar Pradesh

Through : District Magistrate /OCNS /Assistant Director, Allahabad.

I Hiramani w/o Sri Vinod Kumar Dubey R / o B-357, G.T.B. nagar, Allahbad do hereby
solemnly affirm and state on oath as under:
1. That I am not an employee of the State Government of U.P. / Central Government
And Union Territory and undertake to inform the appointing authority and give up the
agency whenever I enter such employment.
2. That none of my near relative is working in the Postal Department (Govt.of India)
In a non-gazetted post bin Allahabad Division.
3. That none of my near relative whom I am dependent on is working in the Postal
Department in a gazetted capacity in U.P.
4. That none of my near relative is working in National Saving Institute (Govt.of India)
National Savings Directorate Govt.of India.
5. That none of my near relative is working in National Savings Institute (Govt.of India)
National Savings Directorate Govt.of U.P. in a gazetted capacity.
6. That I will positively apply for renewal of agency before the 45 days of expiry date of
Agency.
7. That I will procure business myself and I will not do any counter business in the Post
Office if found violating the prescribed norms, my agency may be terminated by the
appointing authority.
8. That I will not sit idle/remain present in the Post Office with of concrete purpose, if
I found violating the prescribed norms my agency my be terminated by the appointing
Authority.
9. I, further declare that none of my relative (i.e. my wife /husband, legimate child/step
chilled, father /step father .mother /step mother brother,/stepbrother, sister ,step sister,
father- in-law, mother/mother-in/law, daughter-in-law) of employee under the Central
/State /Union Territory Government.
OR
10. I give below the particulars of my near relative (i.e. my wife /husband, l legimate
child/step chilled, father /step father .mother /step mother brother,/stepbrother, sister
,step sister, father- in-law, mother/mother-in/law.,daoughter-in-law) of employee
under the Central /State /Union Territory Government.

S.N. Name of Relative Relation with the Applicant Name and Address of the Employee

11. I attach the communications in original form the Head Office /Department, where the
above mentioned person (s) is/are employed. The effect that there is no objection to
me being appointed as agent. (SAS/MPKBY)
12. Agency can be terminated at any time without assigning any reason and I shall raise
no objection against it.
13. I the deponent hereby verify that the contents of affidavit from paira 1 to 12 are true
and correct to best of my knowledge and belief. No part of it is false and nothing has
been concealed there from

(Deponent)
Signed in my presence -.
Witness No.-1 Witness No.-2
Signature Signature
Name Name
Address Address