ਆਪਣੀ ਜਾਣਕਾਰੀ ਭਰੋ

OLD AGE / WIDOW PENSION AFFIDAVIT

I, __________, __________, aged about __________ years (date of birth __________), resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

1. 1. SCHEME APPLIED FOR

1. 2. RESIDENCE AND ELIGIBILITY

1. 3. BANK ACCOUNT FOR DIRECT BENEFIT TRANSFER

1. 4. DECLARATION

VERIFICATION

DEPONENT

Signature: ______________________________
__________

Left thumb impression (if unable to sign): ____________

ATTESTATION

Notary Public / Oath Commissioner
Registration No. and seal: ____________________