Format of Affidavit. (On a Rs.

10 stamp paper)

I _______________________ (Applicant Name as per id proof), residing at

_________________________________________________________________________
___________________________(Address as per address proof) do solemnly affirm and
stated as under:

i. That I have not taken the benefit till now/ have not taken the benefit more than
once under the Scheme of Free Coaching for SC and OBC students being
implemented by Govt. of India.

ii. That I am not a beneficiary of a similar Scheme being implemented by any other
Department/ Ministry of Central Government or State Government in which free
coaching is provided to the students for preparation of competitive exams.

iii. That not more than one brother or sister have taken benefit under the Scheme till
now.

iv. That, if selected under the Scheme, I will take admission in the Coaching
Institute, whose detail has been given by me, within six months of getting the
letter of the selection. Failing which, I will return the entire amount to the
Government of India, as per the mode prescribed by it.

I solemnly state that the contents of this affidavit are true to the best of my
knowledge and belief and that it conceals nothing and that no part of it is false.

(Name and signature of the Deponent)