AFFIDAVIT

I DILBAGH SINGH S/o, LATE SH. SUBE SINGH aged 69 years R/o VILLAGE BOHAR,
GALI LADHAN, DISTT. ROHTAK -124001 HARYANA do hereby solemnly affirm and declare
as under: -
1) That I am life member of Jat Education Society (Regd.), Rohtak bearing Voter Sr. No.
2533 in collegium No. 5018 / 2016 as per voter list published on 19/6/2016.
2)
3) That I am life member of Jat Education Society (Regd.), Rohtak bearing Voter Sr. No.
5629 in collegium No.19 as per voter list published on Election 2012.

4) That I have paid requisite fee to became life member of Jat Education Society
(Regd.), Rohtak.

5) That I belong to JAT community.

6) That my Date of Birth is 03-03-1955.

7) That my name has been mentioned incorrectly in the list of dead life members
whereas I am alive person presently residing at H. No 966, SECTOR -1, ROHTAK
HARYANA –124001.

8) That my mobile number is 94163 03900

9) That I became life member of Jat Education Society (Regd.), Rohtak in the year
1976.
This declaration is hereby executed and submitted to the concerned authorities to remove
my name from the list of dead life members and further for preparation of I-Card. I hereby
state that whatever is stated hereinabove is true to the best of my knowledge. Solemnly
affirmed at Rohtak on this 2nd day of January 2024.

(DILBAGH SINGH)
(Signature of the Applicant).
Deponent
VERIFICATION:
Verified on this day 2nd day of January 2024.at Rohtak that the contents of the affidavit are
true and correct, nothing material has been concealed and no part of it is false.
Deponent