A F F I D AV I T

I, _______________________________, W/o. ____________________________, aged about __

years, Occ: _____________, R/o. ___________________________________________________________
__________________________________ Telangana State, do solemnly affirm and state on oath as under:-

1. That my Child _________________ , Occ: Student, Date of Birth ________ , R/o

_____________________________________________________________________, T.S., belongs
Socially and Economically Backward Class of Muslims comes under SHAIK Category B.C.E. Group & Sl
No.12 as per G.O.Ms. No.23 BCW 9C20, Dated 07-07-2007.
2. That I am a Businessman and I am getting annual income of Rs __________ from all sources and no
other family member is earning member and the above said house is our Own house. Further I submit
that I do not possess any movable or immovable property on my name or my family member’s name.
3. That my Child ____________________ is APPLYING FOR Govt. Service Recruitment for which Creamy
Layer Certificate is required.
4. I therefore, request the concerned authorities to issue the NON CREAMY LAYER CERTIFICATE at any
early date, for the above child for the purpose of Job/Employment.
5. That the state above information and facts are true and correct. If anything found adverse, I shall be
liable to the criminal action taken by you.

Sworn and signed before me

On this the ___ of ___________, 20__
At Hyderabad. DEPONENT