au 2m H@onpfl/ Self Declaration Qecrener rei Lib, pds aud, Yous Apmod / Zam, 18B/4B age coin Conbundmbd Gaucrome Ose 3agi bg AsGald adeeb ede grerurgs B siege Guus JG 5 gorda gAw prox, corer apmieiuLL gecdscr simensg1d rox sibs cirsuled 2eimenn cenajb,ns Zeadeen sreronned LenpasuLsildened cored, Bret s1flss saaKdscr/ sclemisst 2cieniDss Ypburerea crot Vererrehe Asfuagid ucv5H0, OeSw soir eens ol. 177 WpHId 199-6 Sp corde oHors ef Purer pLaydors CopGancreniuGid creirieog slGasr creer) suslrenCan® 2p SushsdlenCper. | am Selvi Thanyashree D daughter of Thiru N Duraimuhil residing at Door No. 18B/4B, street of Kodambakkam Vellala Street 3rd Lane Village / town of Puliyur, Taluk of Egmore, Chennai District, Tamil Nadu State. The details furnished by me are true to the best of my knowledge and believe and nothing has been concealed herein. | declare that | am well aware of the fact that if the information and documents given by me are proved to be incorrect / not true in future, | shall be liable for prosecution under section 177 & 199 of the Indian Penal Code. Signature of the Applicant / wgyeroiér exQuiniusd