lea eee ae ction: datalteto be Letters (7 be vl or 3 months frm doteof sue} [Not required to print on letterhead 272 | [pas [fo 023 [A essen Hon esdennn scorch fx Alta past prota a ekCO 0 O18 IS ee al Fall Names [NSSHA RRA kUmARS ASH kumPR STINWN [ fe: LA House No./ Bldg Apt: street/Road/tane: Landmarks LNEPR- SHEN manorR wrea/tocaity seco | BARARCE BAZAR kKuemrDs wusesrtownscrr = [DAN RAD se = Post Offic: BHVL AN BARA REE _ ise _ DPN BAD oa ae Mise a ial la, Bh, em OE Fan coe: (s2ra73 Vit Rha Kiran} 1939 Then Pe ere Date ot ith ts |[i ‘Name of the Certifir: Ofice Address: contact Number: Sa Se ‘hereby certify above mentioned details ofthe resident Checklist Yor Certier and 1 am a. Tick appropriate box below) aX overaiing Lue dat itited Cincident’s sane EXC etais (0) Gareted omcer-Group A den’ Photos ss ined and ross starped (aope to phat or phot to POPE [7] vitage Panchayat Wead or Munya [5 geet offer croup 2S ereers wert Be acini ci arte ia | hed ona ication Ke oe ae Superintendent/ Warder Matron Head of institution ‘of Recognized shelter homes/ Orphanages ] Pro om Signe a sump te ceeter NOTE: this formats apphicable for PO! documents tS Nos. 17,20, 23, 22,31 832; POA documents tS. Nos 23, 2437, 38,48 & 45; POR documents at I Nos. 12 {214 008 documents aS Nas. 45, 1415 of Schedule ofthe Aaghaa (Enrolment 3nd Update] Reputon, 2016, a amended from time tte,