GHRCE/Admissions/2016-17/form-6

SELF-DECLARATION
(To be filled by Parents)
Applicant’s
Photo

I, __________________ __________________ ___________ Son / Daughter of _______________

_______________ _________________ aged ___________, occupation ___________ resident
of___________________________________________ Pin_____ ________ with UID No. _________
hereby declare as under
1. That ____________ ___________________ _____________is my son /daughter, who was born
on _____ ___________ ______________(in words____________ ______________ ________
____________ __________ ____________________).
2. That my Son/Daughter _________________________________________ can read, write and
speak in Hindi very well and my mother tongue is “HINDI”.
That it is my true statement.

Date: Name & Signature of Applicant

Place: (Parent)

I, hereby declare that the information provided above is true and correct to the best of my personal
knowledge, information and belief. I fully understand the consequences of giving false information.
If the information is found to be false, I shall be liable for prosecution and punishment under Indian
Penal Code and / or any other law applicable thereto.

Place :------------------ Applicant’s Signature (parent)-------------------

Date :------------------ Applicant’s Name :-----------------------