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Forms Odiaportal 355379

This self-declaration form requires the individual to affirm the truthfulness of the information provided in their application. The signer acknowledges their responsibility for the accuracy of the declaration and the potential legal consequences for any misrepresentation. Additionally, it states that any false declaration may lead to the cancellation of the certificate and withdrawal of benefits.

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ghanshyampaik513
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We take content rights seriously. If you suspect this is your content, claim it here.
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889 views1 page

Forms Odiaportal 355379

This self-declaration form requires the individual to affirm the truthfulness of the information provided in their application. The signer acknowledges their responsibility for the accuracy of the declaration and the potential legal consequences for any misrepresentation. Additionally, it states that any false declaration may lead to the cancellation of the certificate and withdrawal of benefits.

Uploaded by

ghanshyampaik513
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SELF DECLARATION

I, Shri / Smt./Miss...................................................................
Son / Daughter / Wife of ...........................................................................
age……….… years, of Village-…………..………..….... P.O. ………….………..……..
District ……………………….. in the state of Odisha do hereby declare that
the information given by me in this application form is true to the best of
my knowledge and I have not suppressed/ misrepresented any fact. That
I am solely responsible for the accuracy of the declaration and
information furnished and shall be liable for action under section 199,
200 and 420 of Indian Penal Code and other relevant laws/rules in case
of furnishing wrong declaration and information. Also, I am well aware of
the fact that the certificate shall be summarily cancelled and all the
benefits availed by me shall be summarily withdrawn in case of
furnishing wrong declaration and information.

Place................................

Date: ………………………………. SIGNATURE

Downloaded from: https://forms.odiaportal.in/

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