Self-Declaration Form

I, _______________________________________________________, age
_____________ years, R/o. _______________________ hereby declare that I am
enrolled as an Advocate on ___________________ with Bar Council of
Maharashtra and Goa.

I state that I am practicing in Civil/Criminal/

Constitution/Revenue/Service matter / _________________________ / /on
appellate/ Original Side of Bombay High Court of Bombay.

I further declare that the Bar Council of Maharashtra and Goa has not
initiated any disciplinary proceeding and has not taken any coercive action
against me at any time.

Hence this declaration

Date:

Place:

Signature