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IN THE COURT OF EXECUTIVE MAGISTRATE::

ITANAGAR/NAHARLAGUN/BANDERDEWA

PAPUM PARE DISTRICT::ARUNACHAL PRADESH

AFFIDAVIT

I Shri/Smt. Suman Kumar, daughter of Shri Tarak Gupta, Permanent resident of village
Naharlagun, Distt.- Papum Pare, State of Arunachal Pradesh and presently residing at ward No-
24 Of D-Sector, Sector of Itanagar/Naharlagun/Banderdewa, District Papum Pare.

1. That Shri/Miss Suman Kumar is my daughter


2. That his/her actual date of birth is on 21.04.2000.
3. That his/her place of birth is at Arunachal Pradesh.
4. That this affidavit is sworn into obtain birth certificate from the competent authority.

DECLARATION

I Shri /Smti. Suman Kumar do hereby declare that the above statements from Para 1 to 4 are true
to the best of my knowledge and belief, if I am furnished wrong information, I shall be liable to
punishment under the registration of Birth and Death Act,1969.

DEPONENT

Executed and signed before me by Shri/Smti. Suman Kumar in my court on this 13 day of
October,2022. (ALL BLANKS IN THIS SECTION TO BE FILLED BY THE
MAGISTRATE).

EXECUTIVE MAGISTRATE

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