INDIA NON JUDICIAL e-Stamp Certificate No. + IN-KA89616279005258R Cortiicate Issued Date 07-Sep-2019 11:07 AM ‘Account Reference 1 NONACC (Fi)/ kacrstl08/ BHADRAPPA LAYOUT/ KA-BA Unique Doc. Reference 1 SUBIN-KAKACRSFL0802237919716645R >) Purchased by : MANJUNATH GONCHIGAR LINGAREDDY < Description of Document 1 Atiole 4 Attidavit Gy Description 1 AFFIDAVIT Consideration Price (Rs.) 2 0 (Zero) First Party 1 MANJUNATH GONCHIGAR LINGAREDDY [ Second Party 1 THE CONSULAR SECTION CPV DIVISION Stamp Duty Paid By 1 MANJUNATH GONCHIGAR LINGAREDDY ‘Stamp Duty Amount(Rs.) 2 100 (One Hundred oniy) For Sri Ronganatha Credit Co-operative Society w+ Pease write oF type Below thi line me AFFIDAVIT 7 |, MANJUNATH GONCHIGAR LINGAREDDY son of LIN DDA_THIMMAPP: DECEMBER 1984, at BALLARI KARNATAKA, India, presently residing at OLD-32, NEW- be nee ET LAYOUT, MATHIKERE, BENGALURU, KARNATAKA, INDIA Tel. No: +91-9481062195/080-23372776 holder of Indian Passport No.17917475 (OLD PASSPORT NO-K2821282) issued at BENGALURU on 26/08/2019 expiring on 25/08/2028 (US Social Security No,767-31-8289) solemnly affirm as follows: i jj) "Tog atric oth lame Coreg told be vrtad at we hebesamo can: Any Scresary le ets on hi Cereal os8 9. Signature of the Applicant Date 07092019 gwoRNTO BEFORE ME Q7 SEP 791g Place: Bengaluru I cameto the United States of America under a1 exchange visitor visa for the periodfrom 24/01/2017 to 26/06/2019. ‘The exchange programme was sponsored by the Government of India /State Government of NOT APPLICABLE in India/Agency of the Government of and financed by the Goverment of 7Agencies of the Government of___/ other. Ihave not signed any agreementicontract with the Government of India or a State Government or a quasi-Government organization. or a University or any public organization in India or any banking or other organization in India by which | have enjoyed any monetary benefits in the form of passage money, stipend, scholarship, study leave or otherwise, | have undertaken to return to India after completion of my studiesitraining in USA. OR Hook a scholarship /loan of Rs. NOT APPLICABLE from (name of the institution), under the national oan scholarship scheme during the year or any other scheme By when Iwas a student at Thave fully repaid the amount due from me, or I have yet to repay the amount of Rs. NOT APPLICABLE | availed of a scholarship under programme of National Overseas Scholarship or any other scholarship (specify) NOT APPLICABLE under Ministry of sanction order No, dated The Government of India spent an amount of US $ and Rs, toward the above scholarship. | refunded the entire amount with interest as per the bond executed. A copy of the certficate of repayment issued by vide letter No. dated. is enclosed, I have not taken any loan from any person or agency in India. My presence is not required in India in connection with civil or criminal proceedings. am married and have not deserted my spouse or children in India K. PEETHAMBARAN a eae gpvocaveesnoreey ‘Signature & Seal of the Notary Public GOVT. OF IND! ‘ No.2, Notary Pool, are city civit Court Compler BANGAORE - 56 ys a i & Seal of the Indian Consular Officer