Gazetted officer name Complete office address should be there

Designation

SPECIMEN CERTIFICATE OF IDENTITY/RESIDENCE

This is to certify that Mr./Mrs./Miss …………………………………………………………………………………………………

Son/daughter/wife/husband/ward of ………………………………………………………………………………………………

Is known to me. His/her photograph is attached and is duly attested by me.

His/Her current address is as under:-

Current Address of the Resident:

Place: (Office Address and Location):

Date:

Signature:

Full Name:

Designation:

Telephone No:

Official Seal

(To be signed personally by the issuing authority. Proxy signatures are not allowed)