Attidavit to be submitted by the Lal ' son, DYo, Wd SYM. affirm and declare as undesse «lo hereby solemnly ‘hat the name of depenatent family member(s) ofthe deponent is namely Sh/Ms, "oat= the date of bith ofthe dependent family member(s) ofthe ponent is "hat -the depenutent family members) of the deponent is/ are not wor anywhere and is/are unemployed and falls deesutnt upon the deponent, However, nthe case employee, the marily income fom al sauces , thy plese ee the seta, {Hat =the deponont's depsndent family members) are not having ‘any income viz. agricultural income, Interest ae, lease gee the deta onthly income crosses the bat of Rs, 9000/- plus dearness CDC recommendation) in resp of is de lacome rental income and any other out That =the aeponent ill ti Fehler month fas por the pendent family ers in futon 8) That thedtepon Slependent family member(s) are not havin ‘any FDR/ Bunk Fiseel Deposits with any bunk or thw nlemse ve he datas pest oftices 7) That - the deponen’s dependent family members) so not have on Delhi orany Depariment/ Authority. yes skate gv the deta 8) Tit =the deponeats dependent amily members) are not having any ' from Government of NT of Dell and sas, pension income from Government of NF of edical/ medical allo rnce/ medica Y / Iealh institutions. yes please ive he That the deponent’s dependent faily members are residing with me or at (reason to be given if such sfepenatent i not resin itl the Government Servant who wishes to seck the henefit), 10) Thats the details vie same, date of Beth and occupational sas of my other fanily members including brothers andl sisters sas una S.No Name Date of bi Relationship Occupational Status 1) That the dependent family members ofthe deponents ate not dependent upon anyother fa ly members except {he doponent 12) That the dependent fasiyweanbrs dont hive any tank acount in any bank. Hes ales ym theatested copies ‘tpi dite han account statement for the tO yea, 13) That-Income/Occupational States of Mleperdent family member(s) was/is {sforeand after joining ofthe Government Serva in this fw), 18) Tha Overs dtl of ovate an ino propery which sin theme of dependent Family: members Se ee servant) 18) That the deport sol sebmi dependeney eine /anderthing epractyskeguiha smedical/ LTC claina ‘ail ofthe dependent family member(s) for reimbursement in future 16) That dhe above information f correct in all aspect Tht the normatin a prof the inomaton i found as o incr the deponent shall be liable for “tsirinary action besides Iga action as deme appropiate hy the Department, 18) Jat th ponent sal be she orn he lcm amount oti fe fog wih Penal interest in such Deponent Verified at New Delhi on the montionad paras 18 are true aay of (vont, sa comet fo the fest of my knowlege a (Year that the above '! belit an nothing material has heen conceal theretiom, "towns ates encur/Poub/oocners with rte smite song ppenion Cee eee eerie ey zpendents/parents. Sehorate Aheaut of dependents > Setar rae teeMOMek red dept dog once et eye igo 2) Gon of erty pret ve, Asche Cat Deponent buen decrng dependency fa per Annexure, lotr 1 Card/Paspor of sarents/dependents pers/éocuments of depensen: ieee 204 of any other proofs elated to any income of sepensentenn se eiiche teams stare he 0 upeesue we are fr non aig faye LIC etc alngarth thew Ofc ID arb] respect cependee ore parems/dependentsANNEXURE-’B’ davit to government servant) spenden! family member (Parents/oroth lerParent tats S/o, Djo, W/o ShyMs. affirm and declare as under: Rio. 1) That Lam wholly dependent upon my son/daughter/daughter-in-law namely Sh/Ms. 2). That~ the date of birth of the deponent is. 3) That the deponent is not working anywhere and is unemployea/In the case of employment, the monthly income from all sources is Rs. Ives, please lve the details 4) That = the deponent is not having any income viz. agricultural income, Interest Income, rental income. SOURCE. _Hyes, please gve the detail, 5) That = the deponent will intimate nil from any oth to this office, if my monthly income crosses the bar of Rs, 9000/- plus dearness relief per month (as per the 7% CPC recommendation) in future 6) That ~ the deponent is not having any FDR/Bank Fised Deposits with any hank or post offices. yer. pease tals 7) That ~ the deponent is not having, WY pension income from Government of NCT of Delhi or any Dey ment / Authority . tyes please give the details, 8) That - the deponent is not having any medical /me a allowance/ mediclaim facility from Government of NCT of Dethi and any dep iment /authority / health institutions, tyes, please give the deta 9) That ~ the deponent is residing with his/her son/daughter/ daughter. law namely Sh/Ms.. at : {reason to be giv deponent is not residing with the Government Servant who wishes to seek the benefit) 10) That- the deponents is not deper dent upon any other family members except the Govern ‘nt Servant wor this department 11) That- the deponent does not have more than one bank account. Myce plese submit the self atesed copies oLupto date bank account statements forthe lait three years af all such bank accounts none or more bank 12) That- Income Status/Occupational status of deponent (dependent) was/is. (before and after joining of the Government Servant working in this office) 15) That Ownership details of movable and immovable property which is in the name of the deponent 14) That the deponent have PAN Card bearing no. is -/have not been issued PAN rl by the issuing authority, That the deponent file/does not file Income Tax Return, Ifyes then submit ITR forthe last three year. That the above information is correct in all aspect. 17) That if the informat "n oF part of the information is found false or incorrect, the deponent shall be liable for legal action as deemed appropriate by the Department Deponent Verification: Verified at New Delhi on the .. eed y Of ceceececceeeeeees(MOMt, ose (years) that the above mentioned paras 1 to 17 are true and correct to the best of my knowledge and bel boon concealed therefrom. and nothing, material has Deponent