au 2m H@onpfl/ Self Declaration Beery ora, grés5rO acre, saingnsog Codurg) sO Armowd / gemb, 366 spa) coin ASG OSG Asuaild adeeb Aedacr weer simguiler Aunt Ae eAgors 4 Su pret, crerennd aupheL geadedr snersgib wren SHES aimaild eer cerayd,crks Seadsen créertd wenpssieslerensd corey, pron gels Saacdscr/ gaisomiscr osinconse YppibuTETans! stom Gerernofe Agfuagis uss5d, Q¥su sermons sit 177 wind 199-er Sip cords HOTS LF Hurer pasos CopGencreniuGid srericng silGasr sre) suBererCam® 2 psuohsdentper. | am Selvan Madhan son of Thiru Sasikumar residing at Door No. 366, street of North Street lage / town of Kannukkudi Melpathi Addi., Taluk of Orathanad, Thanjavur 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