CERTIFICATE FOR ONLY GIRL CHILD/

ONE OUT OF TWO GIRL CHILDREN

(On non-judicial paper of Rs 20/- duly attested by Class 1 Magistrate)

I / We,__________________________(father) and________________________________(mother)
of Miss_________________________(full address to be given) resident of House No.___________
Street/Sector______________Town / City/ Village_____________District/State____________do
hereby solemnly declare and affirm as under:–

1. That I am / we are citizens of India.

2. That Miss____________________born on_________________is our girl child.
3. That we have no male child.
4. That we have the following only two girls and none else :

i) Name ______________________ i) Name ______________________

ii) Date of Birth _________________ ii) Date of Birth _________________

5. That none of the above mentioned two girl children has obtained/availed the benefit
granted under this category, in this University/Institute including its affiliated colleges.

Signature Signature
(Father) (Mother)

Place:
Dated: