Form 26

(See rule 4A) Please affix your

recent passport
size photograph
here

AFFADAVIT TO BE FILED BY THE CANDIDATE ALONGWITH NOMINATION PAPER

BEFORE THE RETURNING OFFICER FOR ELECTION TO BIHAR VIDHAN SABHA
(NAME OF THE HOUSE) FROM 65 BALRAMPUR CONSTITUENCY (NAME OF THE
CONSTITUENCY)

PART A

I KHWAJA BAHAUDWIN AHAMAD son/daughter/wife of KHWAJA SHAHID

HUSAIN aged 60 years, resident of MITTAN GHAT, PATNA CITY, WARD NO. – 59,
POST – JHAUGANJ, PS – CHOWK, DISTRICT – PATNA PIN CODE - 800008 (BIHAR)
(mention full postal address), a candidate at the above election, do hereby
solemnly affirm and state on oath as under :-

1. I am a candidate set up by NATIONALIST CONGRESS PARTY (NCP)

(** Name of the political party)/** am contesting as an independent

candidate.

(** Strike out whichever is not applicable)

2. My name is enrolled in 184-PATNA SAHIB, BIHAR (Name of the Constituency

and the state), at Serial No. 192 in Part No. 120

3. My contact telephone number(s) is 9262737631 and my e-mail id (if any) is

NIL and my social media account(s) (if any) is/are

(i) NIL
(ii) NIL
(iii) NIL
 (4) Details of Permanent Account Number (PAN) and status of filling of Income
Tax return :-
The Financial Year Total Income shown in income
Sl. for which the last tax return (in Rupees) for the
Name PAN Income tax return last five financial years
No
has been filed completed (as on 31st March)
(i) NOT APPLICABLE
NO RETURN (ii) NOT APPLICABLE
AGPPA5251Q FILED
1 Self (iii) NOT APPLICABLE
(iv) NOT APPLICABLE
(v) NOT APPLICABLE

(i) NOT APPLICABLE

(ii) NOT APPLICABLE
2 Spouse No PAN NOT (iii) NOT APPLICABLE
Allotted APPLICABLE
(iv) NOT APPLICABLE
(v) NOT APPLICABLE
(i) NOT APPLICABLE
NOT NOT (ii) NOT APPLICABLE
HUF (If candidate
3 is Karta/ APPLICABLE APPLICABLE (iii) NOT APPLICABLE
Coparcener) (iv) NOT APPLICABLE
(v) NOT APPLICABLE
(i) NOT APPLICABLE
NOT NOT (ii) NOT APPLICABLE
4 Dependent 1 APPLICABLE APPLICABLE (iii) NOT APPLICABLE
(iv) NOT APPLICABLE
(v) NOT APPLICABLE

5 (i) NOT APPLICABLE

 (ii) NOT APPLICABLE
NOT NOT
(iii) NOT APPLICABLE
Dependent 2 APPLICABLE APPLICABLE
(iv) NOT APPLICABLE
(v) NOT APPLICABLE
(i) NOT APPLICABLE
NOT NOT (ii) NOT APPLICABLE
APPLICABLE APPLICABLE (iii) NOT APPLICABLE
6 Dependent 3
(iv) NOT APPLICABLE
(v) NOT APPLICABLE

Note :- It is mandatory for PAN holder to mention PAN and in case of no PAN, it
should be clearly stated “No PAN allotted”.

(5) Pending criminal cases

(i) I declare that there is no pending criminal case against me. (Tick this alternative
if there is no criminal case pending against the candidate and write NOT
APPLICABLE against alternative (ii) below)

OR
(ii) The following cases are pending against me :
(If there are pending cases against the candidate, then tick this alternative and
score off alternative (i) above, and give details of all pending cases in the Table
below)

Table
(a) FIR No. with name 219/2020
POLICE STATION BARSOI
and address of Police BLOCK-BARSOI NIL NIL
Station concerned DISTRICT-KATIHAR
(b Case No. with Name GR NO.- 3869/2020
NIL NIL
) of the Court ACJM-I, KATIHAR

(c) Sections of concerned

Acts/Codes involved
U/S 188 IPC
(give No. of the U/S 127 (A) RP ACT
NIL NIL
Section, e.g. section
…………… of IPC, etc)
(d Brief description of DISOBEDIENCE TO ORDER DULY
PROMULGATED BY PUBLIC
) offence SERVANT, DIPLAYING NIL NIL
HORDINGS AT PUBLIC PLACE
Whether charges have
(e) been framed (mention NO NIL NIL
YES or NO)
If answer against (e)
above is YES, then
(f)
give the date on NOT APPLICABLE NIL NIL
which charges were
framed
Whether any Appeal/
(g) Application for
revision has been filed
NO NIL NIL
against the
proceedings (Mention
YES or NO)
Note :- A separate sheet of the pending case is being filed as Annexure-A which is
part and parcel of this affidavit.
(6) Case of conviction

(i) I declare that I have not been convicted for any criminal offence. (Tick this
alternative if the candidate has not been convicted and write NOT APPLICABLE
against alternative (ii) below)

OR
(ii) I have been convicted for the offences mentioned below: NOT APPLICABLE
(If the candidate has been convicted, then tick this alternative and score off
alternative (i) above, and give details of all pending cases in the Table below)
Table
(a)
Case No. NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

(b) Name of the Court NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

Sections of Acts/ Codes

involved (give no. of the
(c) NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE
Section, e.g. Section
………………… of IPC, etc)
Brief description of
(d) offence for which NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE
convicted
Dates of orders of
(e) conviction NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

(f) Punishment imposed NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

Whether any Appeal

has been filed against
(g) NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE
conviction order
(Mention YES or NO)
(h) If yes answer to (g)
above is YES, give
NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE
details and present
status of appeal

(6A) I have given full and up-to-date information to my political party about all
pending criminal cases against me and about all cases of conviction as given
in paragraph (5) and (6).
 [Candidate to whom this item is not applicable should clearly write NOT
APPLICABLE IN VIEW OF ENTRIES IN 5 (i) and 6 (i), above]

Note :-

1. Details should be entered clearly and legibly in BOLD letters.

2. Details to be given separately for each case under different columns against
each item.

3. Details should be given in reverse chronological order i.e. the latest case to be
mentioned first and backwards in the order of dates for the other cases.

4. Additional sheet may be added if required.

5. Candidate is responsible for supplying all information in compliance of Hon’ble

Supreme Court’s Judgment in W.P (C) No. 536 of 2011.

(7) That I give herein the details of the assets (movable and immovable etc) of
myself, my spouse and all dependents.

A. Details of movable assets :-

Note: 1. Assets in joint name indicating the extent of joint ownership will also have
to be given.

Note: 2. In case of Deposit/Investment, the details including Serial Number,

Amount, date of deposit, the scheme, Name of Bank/Institution and
Branch are to be given.

Note: 3. Value of Bonds/Share Debentures as per the current market value Stock
Exchange in respect of listed companies and as per books in case of non-
listed companies should be given.
 Note: 4. ‘Dependent’ means parents, son(s), daughter(s) of the candidate or
spouse and any other person related to the candidate whether by blood
or marriage, who have no separate means of income and who are
dependent on the candidate for their livelihood.

Note: 5. Details including amount is to be given separately in respect of each

investment.

Note: 6. Details should include the interest in or ownership of offshore assets.

Explanation:- For the purpose of this Form, the expression “offshore assets”
includes, details of all deposits or investments in Foreign banks and
any other body or institution abroad, and details of all assets and
liabilities in foreign countries:
S. No Spouse Depen Depen Depen
Description Self HUF dent -1 dent -2 dent -3
DIVA FAUJI
(i)
Cash in Hand NOT NOT NOT NOT
RS. 45,000/- RS. 22,000/- APPLICABL APPLICA APPLICA APPLICA
E BLE BLE BLE

(ii) Details of deposit in RS. 1146/-

Bank accounts A/C NO.- 31440052388
(FDRs, Term STATE BANK OF INDIA
Deposits and all BRANCH- BAGDAR
other types of
RS. 2000/-
deposits including
A/C NO.- 6929477293
saving accounts) INDIAN BANK NOT NOT NOT NOT
Deposits with BRANCH- MALDA NIL APPLICABL APPLICA APPLICA APPLICA
Financial E BLE BLE BLE
Institutions, Non
Banking Financial
Companies and
Cooperative
societies and the
amount in each such
deposit
(iii) Details of NOT NOT NOT NOT
investment in NIL NIL APPLICABL APPLICA APPLICA APPLICA
E BLE BLE BLE
 Bonds,
Debentures/Shares
and units in
companies/Mutual
Funds and others
and the amount
(iv) Details of
investment in NSS,
Postal Savings,
Insurance Policies
NOT NOT NOT NOT
and investment in
NIL NIL APPLICABL APPLICA APPLICA APPLICA
any Financial E BLE BLE BLE
Instruments in Post
Office or Insurance
Company and the
amount
(v) Personal Loans/
advance given to
any person or entity
including firm, NOT NOT NOT NOT
company, Trust etc. NIL NIL APPLICABL APPLICA APPLICA APPLICA
and other E BLE BLE BLE
receivables from
debtors and the
amount
(vi) Motor Vehicles/
Aircrafts/Yachts/
Ships (Details of
NOT NOT NOT NOT
Make, Registration NIL
NIL APPLICABL APPLICA APPLICA APPLICA
Number, etc, year of E BLE BLE BLE
purchase and
amount)
Jewellery, bullion 30 GRAM
(vii) and valuable GOLD NOT NOT NOT NOT
thing(s) (give details NIL WORTH APPLICABL APPLICA APPLICA APPLICA
of weight and value) RS. 1,50,000/- E BLE BLE BLE
APPROX
Any other assets NOT NOT NOT NOT
(viii) such as value of NIL NIL APPLICABL APPLICA APPLICA APPLICA
claims/ interest E BLE BLE BLE
(ix) NOT NOT NOT NOT
Gross Total Value RS. 48,146/- RS. 1,72,000/- APPLICABL APPLICA APPLICA APPLICA
E BLE BLE BLE

B. Details of immovable assets :-

Note: 1. Properties in joint ownership indicating the extent of joint ownership will
also have to be indicated.

Note: 2. Each land or building or apartment should be mentioned separately in this

format.

Note: 3. Details should include the interest in or ownership of offshore assets.

Depend Depend Depen
S. No Description Self Spouse HUF ent -1 ent -2 dent -3
(i) Agricultural Land
NOT
NOT NOT NOT
Location(s) NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
Survey number(s) LE LE BLE

Area (total NOT NOT NOT

NOT
NIL NIL APPLICAB APPLICAB APPLICA
measurement in acres) APPLICABLE
LE LE BLE
Whether inherited NOT NOT NOT
NOT
NIL NIL APPLICAB APPLICAB APPLICA
property (Yes or No) APPLICABLE
LE LE BLE
Date of purchase in NOT NOT NOT
NOT
case of self acquired NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
property
Cost of land (in case of NOT NOT NOT
NOT
purchase) at the time NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
of purchase
Any investment on the
land by way of NOT
NOT NOT NOT
development, NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
construction etc.
Approximate Current NOT
NOT NOT NOT
market value NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE

(ii)Non Agricultural Land NOT

NOT NOT NOT
Location(s) NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
Survey number(s)
Area (total NIL NIL NOT NOT NOT NOT
 measurement in sq. ft.) APPLICAB APPLICAB APPLICA
APPLICABLE
LE LE BLE
Whether inherited NOT NOT NOT
NOT
NIL NIL APPLICAB APPLICAB APPLICA
property (Yes or No) APPLICABLE
LE LE BLE
Date of purchase in NOT NOT NOT
NOT
case of self-acquired NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
property
Cost of land (in case of NOT NOT NOT
NOT
purchase) at the time NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
of purchase
Any investment on the
NOT NOT NOT
land by way of NOT
NIL APPLICAB APPLICAB APPLICA
development, NIL APPLICABLE
LE LE BLE
construction etc.
Approximate Current NOT NOT NOT
NOT
NIL NIL APPLICAB APPLICAB APPLICA
market value APPLICABLE
LE LE BLE
(iii) Commercial Building
NOT NOT NOT
(Including apartments) NOT
NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
-Location(s) LE LE BLE
-Survey number(s)
Area (total NOT NOT NOT
NOT
NIL NIL APPLICAB APPLICAB APPLICA
measurement in sq. ft.) APPLICABLE
LE LE BLE
Built-up Area (Total NOT NOT NOT
NOT
measurement in sq. NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
mt.) LE LE BLE

Whether inherited NOT NOT NOT

NOT
NIL NIL APPLICAB APPLICAB APPLICA
property (Yes or No) APPLICABLE
LE LE BLE
Date of purchase in NOT NOT NOT
NOT
case of self-acquired NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
property
Cost of Property (in NOT NOT NOT
NOT
case of purchase) at NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
the time of purchase
Any investment on the
Property by way of NOT NOT NOT
NOT
NIL NIL APPLICAB APPLICAB APPLICA
development, APPLICABLE
LE LE BLE
construction etc.
Approximate Current NOT NOT NOT
NOT
market value NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE

Residential Building MAUZA – PANDUA NIL NOT NOT NOT NOT

(iv) APPLICABLE APPLICAB APPLICAB APPLICA
(Including apartments) J.L NO.- 33
 -Location(s) KHATA NO.- 52
LE LE BLE
-Survey number(s) PLOT NO.- 18/356
Area (total NOT NOT NOT
NOT
measurement in sq. ft.) 1742 SQ. FT. NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE

Built-up Area (Total NOT NOT NOT

NOT
measurement in sq. 950 SQ. FT. NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
mt.)

NOT NOT NOT

Whether inherited NOT
NO NIL APPLICABLE
APPLICAB APPLICAB APPLICA
property (Yes or No) LE LE BLE

Date of purchase in NOT NOT NOT

NOT
case of self-acquired 29/11/2006 NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
property

Cost of Property (in NOT NOT NOT

NOT
case of purchase) at RS. 20,000/- NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
the time of purchase

Any investment on the

land by way of NOT
NOT NOT NOT
development, RS. 2,00,000/- NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
construction etc.
Approximate Current NOT NOT NOT
NOT
RS. 16,00,000/- NIL APPLICAB APPLICAB APPLICA
market value APPLICABLE
LE LE BLE
Others (such as NOT
NOT NOT NOT
(v) interest in property) NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
Total of current NOT NOT NOT
NOT
(vi) market value of (i) to RS. 16,00,000/- NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
(v) above
(8) I give herein below the details of liabilities/dues to public financial
institutions and Government:-

(Note: Please give separate details of name of bank, institution, entity or individual
and amount before each item)
S. No Description Self Spouse HUF Depen Depen Depend
dent -1 dent -2 ent -3
(i) Loan or dues to
Bank/Financial
Institution(s) NOT NOT NOT
NOT
Name of the Bank or NIL NIL APPLICABLE
APPLICA APPLICA APPLICAB
BLE BLE LE
Financial Institution,
Amount outstanding,
Nature of Loan
Loan or dues to any other
individuals/ entity other NOT NOT NOT
NOT
than mentioned above NIL NIL APPLICABLE
APPLICA APPLICA APPLICAB
Name (s), Amount BLE BLE LE

outstanding, nature of loan

NOT NOT NOT
NOT
Any other liability NIL NIL APPLICABLE
APPLICA APPLICA APPLICAB
BLE BLE LE

NOT NOT NOT

Grand Total of Liabilities NIL NIL
NOT
APPLICA APPLICA APPLICAB
APPLICABLE
BLE BLE LE

(ii) Government Dues: YES/NO (Pl Tick

(A) Has the Deponent been in occupation of
Dues to departments the appropriate
dealing with accommodation provided by the Government at alternative)
Government any time during the last ten years before the
accommodation
date of notification of the current election? NO
(B) If answer to (A) is YES, the following
declaration may be furnished namely:-
(i) The address of the Government
accommodation: NOT APPLICABLE NOT
APPLICABLE
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
(ii) There is no dues payable in respect of
above Government accommodation,
towards:-
NOT APPLICABLE
(a) Rent
(b) Electricity Charges NOT APPLICABLE

(c)Water charges and

 NOT APPLICABLE
(d) Telephone charges as on …………………… (date)
[the date should be the last date of the third NOT APPLICABLE

month in which the election is notified or any

date thereafter].
Note- ‘No Dues Certificate’ from the agencies
concerned in respect of rent, electricity charges,
water charges and telephone charges for the
above Government accommodation should be
submitted.
Dues to department
dealing with
Government
(iii) transport (including NOT APPLICABLE
NOT APPLICABLE
aircrafts and
helicopters)
S. No Description Self Spouse HUF Dependent Dependent Dependent
-1 -2 -3
Income Tax NOT NOT NOT NOT NOT NOT
(iv) dues APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE
GST dues NOT NOT NOT NOT NOT NOT
(v) APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE
Municipal/
Property tax NOT NOT NOT NOT NOT NOT
(vi) APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE
dues
Any other NOT NOT NOT NOT NOT NOT
(vii) dues APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE
Grand total of
all NOT NOT NOT NOT NOT NOT
(viii) Government APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE
dues
(ix) Whether any NOT NOT NOT NOT NOT NOT
other APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE
liabilities are
in dispute, if
so, mention
the amount
involved and
the authority
 before which
it is pending

(9) Details of profession or occupation:

(a) Self : SOCIAL WORKER AND SPIRITUAL TEACHER

(b) Spouse : HOUSEWIFE

(9A) Details of source(s) of income:

(a) Self : SPIRITUAL TEACHER

(b) Spouse : NIL

(c) Source of income, if any, of dependents : NOT APPLICABLE

(9B) Contracts with appropriate Government and any public company or

companies

(a) details of contracts entered into by the candidate : NOT APPLICABLE

(b) details of contracts entered into by spouse : NOT APPLICABLE

(c) details of contracts entered into by the dependents : NOT APPLICABLE

(d) details of contracts entered into by Hindu Undivided Family or trust in which
the candidate or spouse or dependents have interest : NOT APPLICABLE

(10) My educational qualification is as under: LITERATE

 (Give details of Highest School/University education mentioning the full form of
the certificate/diploma/degree course, name of the School/College/ University
and the year in which the course was completed)

. PART – B

(11) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART – A:

1 Name of the Candidate KHWAJA BAHAUDWIN AHAMAD

MITTAN GHAT, PATNA CITY,
2 Full postal address WARD NO. – 59, POST – JHAUGANJ,
PS – CHOWK, DISTRICT – PATNA
PIN CODE - 800008 (BIHAR)
Number and name of the
3 65 BALRAMPUR BIHAR
constituency and State
Name of the Political Party
which set up the candidate NATIONALIST CONGRESS PARTY (NCP)
4
(otherwise write ‘Independent’)
Total number of pending
5 01
criminal cases
Total number of cases in which
6 NIL
convicted
PAN of Year for which last Total Income
Income Tax Return Filed Shown
(a) Candidate AGPPA5251Q NO RETURN FILED NOT APPLICABLE
NO PAN
7 (b) Spouse NOT APPLICABLE NOT APPLICABLE
ALLOTTED
(c) HUF NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

(d) Dependent NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

Details of Assets and Liabilities (including offshore assets) in rupees

8 Depen
Depen Depen
Description Self Spouse HUF dent-1
dent-
dent-3
2
A NOT NOT NOT
Movable Assets NOT
RS. 48,146/- RS. 1,72,000/- APPLIC APPLIC APPLIC
(Total Value) APPLICABLE
ABLE ABLE ABLE
B Immovable Assets
I
Purchase Price of
NOT NOT NOT
self-acquired NOT NOT
RS. 20,000/- APPLIC APPLIC APPLIC
immovable APPLICABLE APPLICABLE
ABLE ABLE ABLE
property

II Development/
Construction cost
NOT NOT NOT
of immovable NOT
NIL NIL APPLICABLE
APPLIC APPLIC APPLIC
property after ABLE ABLE ABLE
purchase (if
applicable)
III
Approximate
current market
price RS. 16,00,000/- NOT
APPLICABLE NOT NOT NOT
(a) Self acquired NOT
APPLIC APPLIC APPLIC
assets (Total value) APPLICABLE
ABLE ABLE ABLE
NOT APPLICABLE NOT
APPLICABLE
(b) Inherited assets
(Total value)

9 Liabilities
I NOT NOT NOT
Government dues NOT
NIL NIL APPLICABLE
APPLIC APPLIC APPLIC
(Total) ABLE ABLE ABLE

II
Loans from Bank, NOT NOT NOT
NOT
Financial Institutions NIL NIL APPLICABLE
APPLIC APPLIC APPLIC
and others (Total) ABLE ABLE ABLE

10 Liabilities that are under dispute

I NOT NOT
NOT
Government dues NOT APP
NIL NIL APPLIC APPLIC
(Total) APPLICABLE
ABLE ABLE
LICA
BLE
 II Loans from Bank, NOT NOT
NOT
NOT APP
Financial Institutions NIL NIL APPLICABLE
APPLIC APPLIC
LICA
and others (Total) ABLE ABLE
BLE
Highest educational qualification: LITERATE

(Give details of Highest School/University education mentioning the full

11
form of the certificate/diploma/degree course, name of the School/College/
University and the year in which the course was completed)

VERIFICATION
I, the deponent above named, do hereby verify and declare that the contents of
this affidavit are true and correct to the best of my knowledge and belief and no
part of it is false and nothing material has been concealed there from. I further
declare that :-
(a) There is no case of conviction or pending case against me other than those
mentioned in items 5 and 6 of Part A and B above,
(b) I, my spouse or my dependents do not have any asset or liability, other than
those mentioned in items 7 and 8 part A and items 8, 9 and 10 of Part B above.

Verified at S.D.O COURT PREMISES, BARSOI this the 20TH Day of October 2020.

Deponent

Note: 1. Affidavit should be filed latest by 3:00 PM on the last day of filing
nominations.
Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of
the First Class or before a Notary Public.
Note: 3. All columns should be filled up and no columns to left blank. If there is no
information to furnish in respect of any item, either “NIL” or “NOT
APPLICABLE” as the case may be, should be mentioned.
Note: 4. The affidavit should be either typed or written legibly and neatly.
Note: 5. Each page of the affidavit should be signed by the dependent and the
affidavit should bear on each page the stamp of the Notary or Oath
Commissioner or Magistrate before whom the affidavit is sworn.