AFFIDAVIT

Before the Notary Public / Executive Magistrate – First Class

I, Sri / Smt/ Ms. ______________________________________________________ (Name of candidate) , son/

daughter/ wife of Mr. ___________________________________________________ aged about _________ years,
presently residing at _____________________________________________________________________________________
do here by solemnly affirm and declare the followings.

 That, , presently, my name is registered as a registered Nurse / Nurse and Midwife under Odisha
Nurses and Midwives Registration Council.
 That my present Registration number is _____________________ for ANM/GNM/B.Sc/
P.B.B.Sc/M.Sc/PhD course and this Registration number is valid till __________________.
 That, I want to transfer my Nursing Registration from Odisha Nurses and Midwives Registration
Council to ___________________________________________________________________________________________
for higher study / employment.
 That, presently, I am not working in any Govt. / Private Medical Institution / Hospitals /
Educational Institutions providing Nursing Trainings in Odisha.
 That, I am applying for NOC to Odisha Nurses and Midwives Registration Council for
cancellation of my existing Registration from ONMRC.
 That, the above information is true to the best of my knowledge and belief and if, subsequently,
any information given above is found to be false and fabricated, then legal action as deemed
proper will be taken against me.
 That, this affidavit will be submitted to the Registrar, Odisha Nurses and Mid Wives Registration
Council , in short “ONMRC” for issuance of NOC from ONMRC.

Deponent

Advocate

Attested by Notary Public /

First Class Executive Magistrate
** Affidavit on a Rs.100/- Non-Judicial Paper