BEFORE THE NOTARY AT GOLAGHAT

AFFIDAVIT
Date: 25/10/2019
I , SRI ABINASH BHORALI, son of Sri Bipin Bhorali, aged about 25 years,
resident of Kocholial Gaon, P.O. Halodhibari, P.S. Dergaon, Mouza Gurjugonia in
the district of Golaghat, Assam, do hereby solemnly affirm and declare on oath as
under:-

1. That I am a citizen of India by birth and also, a permanent resident of the

above noted address.
2. That I belong to General Category under Sub-Caste Kalita which is not
covered under any of the existing scheme of reservation for SC, ST and
OBC/MOBC.
3. That my family’s gross annual income from all the sources for the financial
year 2018-19 is Rs. 90,000/- (Rupees ninety thousand) only which is below
the maximum income limit prescribed for Income & Assets Certificate to be
produced by Economically Weaker Sections.
4. That my family lives in a Kutcha House No. 109 situated on a plot of land
measuring 00B-01K-00L covered by Dag No. 569 of P.P. No. 187 of Village
Domjariya Kashaliyal, Mouza Gurjugonia, Dergaon Circle, District Golaghat,
Assam, which is owned and possessed by my father, Sri Bipin Bhorali.

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5. That my family owns and possesses the following agricultural lands which is
standing mutated in the name of my father above named:-
a. Land measuring 03B-02K-02L covered by Dag Nos. 2698/453/573 of
P.P. No. 229 of Village Domjariya Kashaliyal, Mouza Gurjugonia,
Dergaon Circle, District Golaghat, Assam;
b. Land measuring 01B-01K-08L covered by Dag No. 2002 of P.P. No.
424 of Village Domjariya Kashaliyal, Mouza Gurjugonia, Dergaon
Circle, District Golaghat, Assam;
c. Land measuring 00B-04K-05L covered by Dag No. 569 of P.P. No.
187 of Village Domjariya Kashaliyal, Mouza Gurjugonia, Dergaon
Circle, District Golaghat, Assam;

Total agricultural land: 05B-02K-15L which is below the limit prescribed

for Income & Assets Certificate to be produced by Economically Weaker
Sections.

6. That, in this way, my family does not own or possess any of the following
assets:-
i. Agricultural Land more than 15 Bigha in rural area,
ii. Residential land in rural area more than 1 Bigha,
iii. Residential plot in Golaghat Municipal Board area more than 1.5
Katha, and
iv. Residential build up area more than 1000 Sq. ft in Golaghat
Municipal Board area.

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 7. That I belong to economically weaker section and meet all the criteria for
awarding/issuing Income and Assets Certificate to be produced by EWS.
8. That this affidavit has been sworn in by me with a view to produce it before
the Circle Officer, Dergaon Revenue Circle, Golaghat District, Assam, for
issue of Income & Assets Certificate in my name.

OATH: I swear that this my affirmation & declaration is true, that it conceals
nothing, and that no part of it is false. So, help me God.

_________________________
Deponent
Solemnly affirmed, declared and signed before me the above facts by the
deponent on this the 25th day of October, 2019, on oath and I certify that the
contents of this affidavit are read over and explained to the deponent and the
deponent seems perfectly understand them.
Identified by:

(S.K. Shah, Advocate) (Notary, Golaghat)

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