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~dm@@rhvif'eof SM. ............................................................aged

................ysan, mident of-- -

1. %I h m filed my application for h e poet of..........................................

2. l ......................... (Number) living children as an today. Out of
h
which no. Of chilcken after 28 th March, 2005 is ....;............................
.(Mentiondaw ofb
& if any)
3. 1am aware that if any total number of living childm are mars than WQ
due to tha children born after 28 th b$arch,2006 ,I am liable to be disqualified for
the same post.
4

Place :-

Date :-