DECLARATION

I__________________________________S/D/o________________________________
aged ____________ residing at ____________________________________________________
______________________________________________________________________________
______________________hereby solemnly affirm and state as under:-

1) That I acquired my Degree/Diploma/ITI in _______________(discipline) in the year

_____________ from University/ Institute at_________________(Place). The duration of
Degree/Diploma/ITI is ___________ years and date of declaration of my final result is
__________________.

2) That after passing the above said examination-

a) I do not have job experience of one or more years.

b) I did not undergo Apprenticeship Training at any place under the Apprenticeship Act
after completion of my Degree/Diploma/ITI.

VERIFICATION

I solemnly affirm that the statement contained in the above paragraph are true to the best
of my knowledge, information and belief and that nothing material has been concealed from
being disclosed.

Date______________ Signature______________

Place _____________ Name ________________