DECLARATION FORM

(As required vide Army No Letter No A/00651/ord 8(1 of R) (A) dated 07-07-1988)
No Rank Name hereby declare that
have been shifted permanently from District My new and old address are as
under-

NEWHOME ADDRESS OLD HOME ADDRESS

House No/Name House No/Name
Village Village
Post Office Post Office

Police Station Police Station

Tehsil Tehsil

District District

State & Pin State&Pin

Distance from Rly Stn Distance from Rly Strn

amofenclosing
amendment
2 my discharge
home address which is certificate
required toSIsubmit formy discharge
No. my declaration along with necessary
to my

records i e after verification by your office and my old Zilla Sainik Board Office

T0
ZilaSainik Welfare Officer Signature of the individual
Dated

REMARKS OF THE ZILLA SAINIK WELFARE OFFICE

The new home address If the individual has been verified and found correct and it
recommended that the same may please be amended in his discharge certificate

Above declaration along with discharge certificate of the individual is submitted to Zilla Sainik
Board _(triplicate) of his verification and onward submission to Records_
for necessary amendment in discharge certificate under intimation to this office

No Department of Sainik Welfare and

Date Resettlement District

Letter No Dept of Sainik Welfare and Resettlement

The Officer-in-charge
Records MEG Bangalore
PIN 900 493
Clo 56 APO

Sir
SUB:CHANGE OF HOME ADDRESS
On verification it has been ranspired that the above named individual has permanently shifted
rom his old address and is recommended that his new home address may be changed in has discharge
certificate. Declaration ith attested copy of discharge certificate of the individual is forwarded herewith
for necessary amendment in the service
records
2 You are requested to fwd acdress slip at the earliest for amending in discharge certificate

Yours faithfully

Department of Sainik Welfare and Resettlement