For Regular/Contract Employees on Stamp Paper of Rs.

10/- or above

AFFIDAVIT

I _______________________________ working as _____________________________ on

Regular/Contract ( to ) basis and particulars of my dependent family
members are given as under:
Remarks
Sr. Name of Dependents DoB/Age Relationship NIC No.
(Student/housewife/etc.)
1
2
3
4
5
6
7
8
9
10

I hereby certify that above information is correct to my best knowledge/believe:

(i) My wife, children (Having an age of 18 years & above), parents, husband and step
children as specified in the PARC employees (Medical Attendance & Treatment
Regulations – 1990) and listed above are actually residing with me and are fully
dependent upon me.
(ii) The change in number of dependents taking place due to marriage of daughters or sons
no longer remains dependents would be communicated as & when such change occur.
(iii) The above mentioned dependents have no other source of income or support from other
brother/sister to meet the expenditure on their treatment. If any discrepancy found in
this regard I will be liable to return whole expenditure and liable to be proceeded under
prevailing PARC Rules/Regulations.

Signature:____________________
Date:________________________
Designation:__________________
CNIC No. ____________________