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5 Local Person Declaration Form PDF English - PDF

This document is a declaration by local people delaying the registration of a birth. It states that [1] the exact date of birth of an individual is a certain date and they were born in a specific village, [2] it provides the father and mother's names, and [3] the information is being declared as true by five witnesses who provide their signatures and witness details. The candidate, father, mother and panchayat pradhan also provide signatures with date and place.

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DJ RAHUL ASHIK
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2K views

5 Local Person Declaration Form PDF English - PDF

This document is a declaration by local people delaying the registration of a birth. It states that [1] the exact date of birth of an individual is a certain date and they were born in a specific village, [2] it provides the father and mother's names, and [3] the information is being declared as true by five witnesses who provide their signatures and witness details. The candidate, father, mother and panchayat pradhan also provide signatures with date and place.

Uploaded by

DJ RAHUL ASHIK
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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DECLARATION BY LOCAL PEOPLE FOR DELAYED REGISTRATION OF BIRTH

We are the local people, residing at Vill ………………………………………. P.O.…………………………………………..… 

P.S.…………………………………… Dist.………………………………………….. Pin………………………… West Bengal.

Do hereby solemnly affirm and declare under.

A) That exact date of birth of …………………………………………….…. is ………………………………….……… 

Born at Vill……………………...……… P.O.………………………………... P.S.………………………………...……… 

Dist.…………………………………….. Pin……………………………………….. West Bengal.

B) That his/her father is ……………………………………………………………………………………………………… 

C) That his/her mother is …………………………………………………………………………………………………….

The above information is true and correct to best of our knowledge and belief.

Witness Details:

Signature of
Sl. No. Name of witness Epic no. of witness Address of witness
witness

1.

2.

3.

4.

5.

Signature of candidate:………………………………… 

Signature of father:………………………………………  Signature with stamp

Signature of mother:……………………………………  Panchayat Pradhan

Date:

Place:

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