(To be printed on Company/Entity letterhead and duly signed and affixed with

company/entity seal)

Self-Declaration Annexure

Declaration
I, (full name) ……....................................................................................................................
S/o, D/o, W/o, H/o ...............................................................................................................
Managing Director/ Director/ Proprietor/ Partner/Authorised Representative of M/s.
.............................................................................................................................................
............…………………………... (Complete address), do hereby solemnly affirm and declare that
all information and documents provided by me/us and the particulars stated above in the
application are true and correct to the best of my knowledge, information and belief.

Place : Signature and

Seal
Date:

(Proprietor/Mg.Partner/Chief Executive/Managing Director/Authorised Representative)