AFFIDAVIT

I DIPTI BHUSHAN (ROSARIN) designer KHADI GRAM UDYOG BHAWAN,

DELHI,, do here by solemnly affirm and declare as under:

1 That I hereby declare the my institution is producing the

Khadi and it s relative products and is a reputed
institution having registered office at chattarpur
Extension, Delhi
2 That I hereby declare that my institution is producing hand
–spun and hand woven cloth khadi and its related products.
3 That I hereby declare that the material produced by the
institution is up to its standard, best quality laboratory
tested.
4 I hereby undertake that I will supply khadi and its related
products under the approved budget /target fixed by KVIC.
5 I hereby undertaking if my institution will supply khadi and
its related products beyond the approved budget/target,
KGB/KVIC can take action under the rules and regulations of
KVIC
6 That our institution will demand payment according to
sales,
7 That I herby declare and undertake that If any defects will
be noticed at any stage in respect of quality of our
products institution will be held responsible for legal
consequences under the law in force like the return ofgoods,
withheld of payment and ban of i8nstitution etc.

I further declare that the above statement is true and correct to

the best of my knowledge and belief and verified on 10th day of
June 2024.
DEPONENT

Annexure "B"
 Format for declaration by the Applicant for Code of Integrity & conflict of
interest

REF NO. ___________________________________

To
MOHD YAMEEN
PROPREITOR OF ROHIL FURNITURE WORKS
SITUATED AT C-95, GALI NO 1, CHAND BAGH, NEAR BHAJANPURA RED LIGHT,
DELHI 110094.
Sir
With reference to your Tender No __________________________________ dated
____________________ I/We hereby declare that We shall abide by the Code
of Integrity to, Public Procurement as mentioned in Page No 18 & have no
conflict of interest as mentioned in Page no. 18.
The details of any previous transgressions of the code of integrity with any
entity in any country during the last three years or of being debarred by any
other Procuring Entity are as under
(a) -----------
(b) ---------
(c) --------
We undertake that in case of transgression/ contravention of the Code of
Integrity, their name is likely to be deleted from the list of empanelled
contractors, besides any other penalty or more severe action as deemed fit.
Thanking you,
Yours sincerely,
Signature
(Name of the Authorized Signatory)
Company / Firm Seal

INCOME AFFIDAVIT

I, SATISH KUMAR (AADHAR CARD 6307 8577 6370) S/O LATE RAM
JATAN R/O H-263, OLD SEEMAPURI, DELHI 110095, do hereby declare that:-

That my/our annual income from all sources e.g. Daily Labourer specially all
types of other sources) including that of my spouse nd unmarrried childerns
is Rs 6,84,000/-(Rs Six Lakh and Eight Four Thousand only) per annum
procedding last three financially year (i.e. Rs 2,28,000/- (Rs Two Lakh and
Twenty Eight Thousand only) per annum from April 1, 2020 to March 31,
2023 .

DETAILS OF INCOME

1 My total income during the last financial year sources of income

therof Rs 2,28,000/- (Rs Two Lakh and Twenty Eight Thousand only)
2 Income of my spouse and unmarried childern during the last
financial year and sources of income there of
 …………… NIL ……………….

Gross Total Income Rs 2,28,000/- (Rs Two Lakh and Twenty Eight Thousand
only)

I am enclosing the bank statements for last six months and declaring that
there are the only Bank Account held by with spuse and Unmarried Childern.

DETAILS OF INCOME

a) Name of Bank :- ICICI BANK LTD

b) ACCOUNT NO :- 040001516012
c) USER NAME:- SATISH KUMAR
d) IFSC CODE:- ICIC0000400

Further I herby undertake that if any stage it is found that information given
by me is false, then beside provided by the Hans Foundation under Little
Heart Programme can be recovered with panel interest and legal action
deemed for any be taken against me.

Sworn 30th Day of November 2023

Name :- Satish Kumar

Signature

AFFIDAVIT

I, MINAKSHI KAMALIA W/O LT. SH. UMA SHANKAR KAMALIA RESIDENT OF

A-2/9, RANA PRATAP BAGH, DELHI-110007, do here by solemnly affirm and
declare as under:

1 That I am citizen of India

2 That my son YASHASV KAMALIA is a bonafide student of Mahavir
Senior Model School, Sangam Park Ext., GT Karnal Road, Delhi-
110033
 3 That my totally family income including of my spouse from all
sources is RS ____________________ /- (Rs ________________________
only) per annum.
4 That I am not paying any income tax.
5 That the contents of the accompany Application for freeship/free
concession are tore and correct which I have been made explained
to me and I undertake to abide by it without any reservation
6 The Decision of the committee will be final and binding on me.

7 That it is our true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 15th Day of April, 2024 that the contents of
this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.

DEPONEN
T
 AFFIDAVIT

I, SUSHIL KUMAR S/O MANGAL SINGH R/O 2141, DHOBI WADA, KINARI
BAZAR, CHANDNI CHOWK, DELHI 110006, do here by solemnly affirm and
declare as under:

1 That I am citizen of India

2 That I am living above said address.
3 That MY Ward Name is HIMANI NIRAMAN and her date of birth is
21.11.2005.
4 That my family totally income of Rs 3,00,000/- (RS Three Lakh
only) per annum from all sources.

5 That it is our true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 23rd Day of August 2023 that the contents
of this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.

DEPONEN
T
 AFFIDAVIT

I, DINESH KUMAR S/O HARI RAM R/O 1607, HIMMAT GARH, BAZAR SITA
RAM DELHI 110006 do here by solemnly affirm and declare as under:

6 That I am citizen of India

7 That I am living above said address.
8 That HARI RAM PAWAR AND HARI RAM both are same and one
person.
9 That I have one BSES Electricity Meter vide CA NO 100442174 and
its registered in the name of my father but I deposit the electricity
bill from my own funds.
10 That I don’t have any Bank Account in any Private or Govt. India or
aboard.
11 That my family totally income of Rs 96,000/- (RS Ninety Six
Thousand only) per annum from all sources.

12 That it is our true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 27TH DAY OF APRIL 2023 that the contents
of this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.

DEPONEN
T
 AFFIDAVIT

I, MOHD RIYAZ S/O BABU R/O 2506, FIFTH FLOOR, NAAZ APARTMENT,
TIRAHA BEHRAM KHAN, GALI KUCHA BAQAULLA, DARYA GANJ, DELHI
110002, do here by solemnly affirm and declare as under:

1 That I am citizen of India

2 That I am living above said address.
3 That my ward name is SAMMIA and her date of birth is
16.03.2004.
4 That she is studying in ZAKIR HUSAIN COLLEGE OF DELHI
(EVENING SHIFT), Delhi in B.A. (Pass) Fifth Semester Third
Year.
5 That my family totally income of Rs 1,00,000/- (RS One Lakh
only) per annum from all sources.

6 That it is our true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 13th Day of January 2024 that the contents
of this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.

DEPONEN
T
 AFFIDAVIT

I, MOHSIN MALIK S/O NAWAB AHMED R/O 423, TOP FLOOR, MATIA MAHAL
NEAR JAMA MASJID, DELHI 110006, do here by solemnly affirm and declare
as under:

1 That I am citizen of India

2 That I am living above said address.
3 That my ward name is FARIHA MALIK and her date of birth is
21.06.2016.
4 That my ward is studying in HAPPY SCHOOL, in CLASS III
SECTION A.
5 That my family totally income of Rs 84,000/- (RS Eighty Four
Thousand only) per annum from all sources.

6 That it is my true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 30TH Day of May, 2024 that the contents of
this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.
 DEPONEN
T
 AFFIDAVIT

I, MOHAMMAD MUSTABEEN (AADHAR CARD 4875 2010 2929) S/O

MUSTAFA HASAN R/O M 104, ABUL FAZAL ENCLAVE, JAMIA NAGAR, NEW
FRIENDS COLONY, DELHI 110025 , do here by solemnly affirm and declare
as under:

1 That I am citizen of India

2 That I am living above said address.
7 That my ward name is ARHAAN and his date of birth is
18.11.2012.
8 That my ward is studying in HAPPY SCHOOL, Darya Ganj, Delhi,
in CLASS VII SECTION A.
3 That my family totally income of Rs 96,000/- (RS Ninety Six
Thousand only) per annum from all sources.

4 That it is our true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 03RD Day of June, 2024 that the contents
of this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.

DEPONEN
T
 AFFIDAVIT

I, RAIS AHMAD S/O MAMOON AHMED R/O 466 GALI BAHAR WALI, CHHATT
LAL MIYAN, DARYA GANJ, DELHI 110002, do here by solemnly affirm and
declare as under:

1 That I am citizen of India

2 That I am living above said address.
3 That my ward name is RAZI AHMED and his date of birth is
27.09.2008.
4 That she is studying in H.M.D.A.V. SR. SEC SCHOOL Delhi in
Class XI Section _____ .
5 That my family totally income of Rs 1,80,000/- (RS One Lakh
Eighty Thousand only) per annum from all sources.
6 That I and ward both are muslim and which comes in Muslim
Minority Category.

7 That it is our true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 17TH Day of May 2024 that the contents of
this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.
 DEPONEN
T

AFFIDAVIT

I, RAVI S/O PRAHLAD R/O C-42, R -29, HARIJAN BASTI, 100 QTRS. DELHI

GATE, DELHI 110002 , do here by solemnly affirm and declare as under:

1 That I am citizen of India

2 That I am living the above said address with my family from a long

time.

3 That my ward name is SAKSHAM TANK and his date of birth is

21.12.2009.
4 That he is studying in H.M.D.A.V Sr. Sec. School, , Delhi in Class
VIII Section ______.
5 That My Family totally income from my all sources is Rs. 96,000/- (RS

Ninety Six Thousand only) per annum .

6 That it is my true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 25th day of July 2023 that the contents of

this affidavit are true and correct to the best of our knowledge and nothing

has been concealed therefrom.

 DEPONENT

AFFIDAVIT

I SANDEEP (AADHAR CARD 6432 6930 1272) S/O SITA RAM SHARMA R/O
333, KUCHA MIR ASHIQ CHAWRI BAZAR DELHI 110006 , do here by
solemnly affirm and declare as under:
1 That I am citizen of India
2 That I have been living the above said address
3 That my wife name is SEEMA SHARMA.
4 That my daughter name is HIFZA and she had born on dated
17.07.2019 at Lok Nayak Hospital
5 That I could not receive my Daughter birth certificate from
Concern Authority due to Covid -19.
6 That my Daughter is Physically and Mentally Fit for Class
Nursery.
7 That it is my true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 30th day of March 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I, NIDA SEHER W/O SYED MOHAMMAD AKRAM R/O 486, CHATTA HAJI
YUSUF, CHORI WALAN, JAMAM MASJID DELHI 110006 do here by solemnly
affirm and declare as under:
1 That I am citizen of India
2 That my income in the previous financial year 2020-21 is RS
84,000/- PER ANNUM from my all sources other than salary
without allowing any deduction as per details given beow:-
Name of sources Income
Salary Account 1,20,000/-
3 That the income of my wife of my my family who depended on
me in the in the previous financial year 2020-21 is RS NIL
4 No individual income tax return was required to be filed in
respect of the aforesaid income in para 1 and 2
5 That it is our true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 23rd day of March 2021 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I, AMAN (AADHAR CARD 6210 9982 0830) S/O AJIT R/O B-237, M.C.D.
FLATES, B BLOCK, NEW USMANPUR, SEELAMPUR DELHI 110053, do hereby
solemnly affirm and declare as under:

1 That I am citizen of India

2 That I am living the above said address with my family.
3 That ASIL SEKH is my real son and his exact and correct date of birth
is 13.07.2018 { Day :- Thirteen, Month:- July, Year :- Two
Thousand and Eighteen).
4 That his mother’s name is JANNATUL FIRDAUSI.
5 That if any information or submission including the statement in the
affidavit is found to be false or incomplete at the any stage, I
understand that I am liable for prosecution under the relevant law.

6 That it is my true and correct statement.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 20th day of January 2023 that the contents
of this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I, MONTU JAIN S/O LATE JAI RAJ KUMAR JAIN R/O 2714, CHOWK RAIJI
DHARAMPURA NAI SARAK DELHI 110006, do here by solemnly affirm and
declare as under:

1 That I am citizen of India

2 That I am living the above said address with my family from a long
time.
3 That my ward name is NIMIT JAIN and his date of Birth is
18.08.2007.
4 That my ward is studying in RAMJAS SCHOOL, PUSA ROAD, DELHI
IN CLASS XI SECTION B.
5 That my Family totally income from my all sources is RS 1,11,600/-
(RS One Lakh Eleven Thousand Six Hundred only) per annum.
6 That it is my true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 23rd Day of May 2023 that the contents of
this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I, IDREES AHMED (AADHAR CARD 4957 4874 7809) S/O KAMALUDDIN

R/O KH NO 28/4 28/5, FIRST FLOOR, STREET NO 10, SANGAM VIHAR, DELHI
110084, do here by solemnly affirm and declare as under:

1 That I am citizen of India

2 That I am living the above said address with my family from a long
time.
3 That my ward name is MOHD ALTAMASH and his date of Birth is
03.03.2008.
4 That my ward is studying in GOVT BOYS SENIOR SECONDARY
SCHOOL, BURARI, DELHI IN CLASS X SECTION F.
5 That my Family totally income from my all sources is of Rs. 1,50,000/-
(RS One Lakh and Fifty Thousand only) per annum.
6 That I and my ward both are Muslim and which comes in Muslim
Minority Category.
7 That it is my true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 21st Day of November, 2023 that the

contents of this affidavit are true and correct to the best of our knowledge
and nothing has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I, MUMTAZ SIDDIQUI (AADHAR CARD 5969 3145 1746) S/O HABIB

AHEMAD R/O 4581/15, THIRD FLOOR, GALI NO 15,ANSARI ROAD, DARYA
GANJ, DELHI 110002 , do here by solemnly affirm and declare as
under:

1 That I am citizen of India

2 That my ward Name is HUZAIFA SIDDIQUI and her date of birth
is 10.12.2012.
3 That my ward is studding in BAL BHARTI AIR FORCE SCHOOL,
LODHI ROAD, Delhi in Class IV Section E.
4 That I could not submit my Ward Fees session August 2021 to
March 2022 due to I was admit in hospital for Operation
Purpose (STOMACH TUBERCULOSIS) and I have submitted my all
saving balance in hospital for my operation.
5 That my office/Business has closed due to Covid 19.
6 That my family totally income from my all sources is Rs. NIL
from 2021.
7 That I requested you that please waiver off my ward all fees
of above said session and in future I will submit my ward
school fee on time.
8 That it is our true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 17th day of February 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT

AFFIDAVIT
 I, RAVINDER KUMAR S/O LATE DAL CHAND R/O C-34/2, NEW GOVIND
PURA, GANDHI PARK, DELHI 110051, do here by solemnly affirm and
declare as under:
1 That I am citizen of India
2 That I am living the above said address from a long time.
3 That now I am working in POOJA GARMENTS situated at G-
19,JAGAT PURI, 40 FT ROAD, DELHI as Field Officer.
4 That My family Totally Income from all sources is Rs.
17,500/- (Rs Seventeen Thousand and Five Hundred only) Per
Month.
5 That it is our true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 17th day of Augsut 2021 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT

AFFIDAVIT

I, MOHD AZAM (AADHAR CARD NO 5742 7980 3461) S/O MR ABDUL

QAYOOMR/O C-75A, GALI NO 7, NEAR JAMA MASJID, GHONDA, DELHI
110053, do here by solemnly affirm and declare as under:
 1 That I am citizen of India
2 That I am living the above said address with my family from
a long time.
3 That my ward name is MOHD SUFIYAN (AADHAR CARD 7932 8824
0417) and His Actual and correct date of birth is
30.09.2010 and my ward’s Mother name is MARYAM JAHAN (AADHAR
CARD 7388 4197 9833).
4 That it is our true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 23rd day of September 2021 that

the contents of this affidavit are true and correct to the best
of our knowledge and nothing has been concealed therefrom.

DEPONENT

AFFIDAVIT

I MD IRFAN DEHELVI S/O HAJI ABDUL REHMAN R/O 1638, KUCHA DAKHNI
RAI, DARYA GANJ,NEW DELHI 110002, do here by solemnly affirm and
declare as under:
 8 That I am citizen of India
9 That I am living the above said address with my family from
a long time.
10 That my annual income from all sources is Rs. 1,00,000/- (RS
One Lakh only) per annum.
11 That it is our true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 24th day of August 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT

AFFIDAVIT

I, CHANDER MANI GOSAIN S/O J. C GOSAIN R/O 918 DR MUKHERJEE

NAGER DELHI 110009 do here by solemnly affirm and declare as
under:
1 That I am citizen of India
2 That I am living above said address.
 3 That I am authorized owner of Vehicle Registration no DL2CAW
8541 and my vehicle had accident with bike on dated
18.11.2021 at 10.15 a.m.
4 That there was no loss life and no police complaint
registered related and no third party damages.
5 That in case if there will be any third party claim related
to this incident it will take the fully responsibility for
the same.
8 That it is our true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 23rd day of November 2021 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT

AFFIDAVIT

I, HABIB UR REHMAN S/O ATAUR REHMAN R/O 337, GALI BUDHAN

RAI, DELHI GATE, DARYA GANJ, NEW DELHI 110002 do here by solemnly
affirm and declare as under:
1 That I am citizen of India
2 That I am living the above said address with my family from
a long time.
3 That my Family totally income from my all sources is Rs.
2,00,000/- (RS Two Lakh only) per annum.
 4 That I am working in private sector as Sales Man and I am
getting my salary in cash mode.
5 That my wife name is NAHID TALAT and she is house wife and
she is not working in any Government Department or Private
department till now .
6 That my wife is owner of the 337, Third Floor, GALI BUDHAN
RAI, DELHI GATE, DARYA GANJ, NEW DELHI 110002 without roof
rights area 39 sq. yards and my wife is living with my
family.
7 That I and my rest of the all family members are not filing
Income Tax Return.
8 That it is my true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 18th day of April 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT

AFFIDAVIT

I, MOHD SABREEN (AADHAR CARD 7336 4659 2374) S/O ASHIQUEEN R/O
M4, DDA QUARTERS, TURKMAN GATE, DELHI 110006 do here by solemnly
affirm and declare as under:
1 That I am citizen of India
2 That I am living the above said address with my family
from a long time.
3 That my ward name is HALEEMA SABREEN and her Date of
Birth is 19.04.2016.
4 That my ward has fully vaccinated but I have lost my ward
vaccination card from my house.
 5 That my ward is physically and mentally fit for K.G.
6 That it is my true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 23rd day of April 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT

AFFIDAVIT

I, BHAGWAN DASS S/O LATE RAM PRASAD R/O B-5/430, SECTOR 3,

ROHINI, DELHI 110085, do here by solemnly affirm and declare as
under:
1 That I am citizen of India
2 That I am living the above said address with my family
from a long time.
3 That my ward name is VANSHIKA and her Date of Birth is
01.08.2013.
4 That my ward is studying in BAL BHARTI PUBLIC SCHOOL,
ROHINI DELHI in Class IV Section C.
5 That I have self arranged Private Cab Vide Registration
No. DL12CC 3707 for my Ward.
 6 That incase if some issue or problem will come out
regarding the private cab or Driver MR JASPAL S/O
CHATARPAL then I will fully responsible for it and the
School or School’s authority will not responsible in any
manner.
7 That it is my true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 11th day of May 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I, HABIBUR REHMAN S/O ATAUR REHMAN R/O 337, KATRA BUDHAN RAI
BAZAR DELHI GATE DARYA GANJ DELHI 110002, do here by solemnly
affirm and declare as under:
1 That I am citizen of India
2 That I am living the above said address with my family
from a long time.
3 That I am Hawker and I am selling cloth on road site
during 08.00 a.m. to 11.00 a.m. at Chitli Qabar Bazar
Matia Mahal, Jama Masjid, Delhi.
4 That my family totally income from all sources is RS
2,00,000/- Per Annum
5
6 That it is my true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 11th day of May 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

Witness DEPONENT
1

2
 AFFIDAVIT

I, ARJUN TYAGI S/O SH CHAUDHARY AZAM TYAGI R/O 5/96, GROUND

FLOOR, TYPE -1, JAWAHAR LAL NEHRU MARG, MAMC CAMPUS, DELHI
110002, do here by solemnly affirm and declare as under:
1 That I am citizen of India
2 That I am living the above said address with my family
from a long time.
3 That My real brother name is ARMAN TYAGI (AADHAR CARD
9770 1808 8120) and his physically disable person and he
has also Disability card issued from government of India.
4 That my real brother ARMAN TYAGI is living with us
5 That I have one domestic electricity connection in my own
name vide CA NO 152489430.
6 That I don’t have any objection if my real brother will
use the above said electricity Bill for his pension
purpose.
7 That it is my true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 22nd day of June 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I DHARMENDRA PRASAD S/O Gouri Shanker R/O 1099, TYPE II, GULABI
BAGH, DELHI 110007, do here by solemnly affirm and declare as under:

1 That I am citizen of India

2 That I am living the above said address with my family from a long
time.
3 That my ward name is ANJALI and her date of birth is 25.08.2006.
4 That My ward is studying in K.V.S., SHALIMAR BAGH, DELHI IN
CLASS XI SECTION B, vide Registration No 11306.
5 That my ward is belongs to SCHEDULED TRIBES (S.T.) but
unfortunately my ward registration as per School Record is General
Category.
6 That my ward is belongs to SCHEDULED TRIBES (S.T.) by birth.
7 That it is my true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 25th day of August 2022 that the contents
of this affidavit are true and correct to the best of our knowledge and nothing
has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I, S K YADAV S/O LATE SHRI K. S. YADAV R/O E-3A, IMLI LAIN,

RAILWAY NORTH COLONY, MORADABAD, UTTAR PRADESH 244001, do here by
solemnly affirm and declare as under:

1 That I am citizen of India

2 That I am General Sectary of ALL INDIA OBC RAILWAY EMPLOYEES
ASSOCIATION/NR .
3 That our association not has any dispute or any member/s of
our association not has/have any objection in any manner.
4 That it is my true and correct statements.

DEPONENT

VERIFICATION:-

Verified at Delhi on this 29th day of August 2022 that the

contents of this affidavit are true and correct to the best of
our knowledge and nothing has been concealed therefrom.

DEPONENT
 AFFIDAVIT

I, ATAHAR ASIF (AADHAR CARD 5452 8802 3144) S/O MOHD ASIF
IQBAL R/O 2853, BULBULI KHANA, SITA RAM BAZAR, DELHI 110006, do here
by solemnly affirm and declare as under:

1 That I am citizen of India

2 That I am living the above said address with my family by birth.
3 That I am Muslim and which comes in Muslim Minority Category.
4 That it is my true and correct statements.

DEPONENT
VERIFICATION:-

Verified at Delhi on this 07th day of September 2022 that the

contents of this affidavit are true and correct to the best of our knowledge
and nothing has been concealed therefrom.

DEPONENT

AFFIDAVIT FOR CADAVERIC TRANSPLANT REGISTRATION

I, OWAIS BILAL (AADHAR CARD 8906 9952 5027) S/O MUKHTAR AHMED R/O

1185, GALI CHOWKIDAR WALI, HAVELI HISSAMUDDIN HAIDER, BALLIMARAN, DELHI

1100006, declare that I am suffering from end stage renal disease and am
currently on maintenance hemodialysis at ANJUMAN MEDICAL CENTER and I

have advised kidney transplantation as a better treatment option by my treating

nephrologists, but there is nobody in my family to donate kidney to me since

• I am having Blood group B+, and my mother B+, my father Expired, my

brother/sister/wife/husband B+ and there is no blood group matching between me

and my close family members

• Or they (my relative) are suffering from disease Mother and Sibling are

diabetic and wife is having seizure disorder.

• Or they (my relations) are not willing to donate kidney to me

So kindly register me for deceased donor kidney transplantation in AIIMSD. I am

aware there is a long waiting list in each blood group for deceased donor kidney

transplantation, and it is not possible to predict availability.

I certify that I am not simultaneously enrolled in any other transplant

programme/hospital for deceased donor kidney transplantation.

I understand that if I register at another hospital for Cadaveric transplant, my

registration at AIIMS, New Delhi will get cancelled.

Place New Delhi Signature

Date 20th day of October 2022 Name