AFFIDAVIT

I, Sri. Kalicharan Satapathi aged about 54 years, S/o late Purastama Satapathy of
Village: ;Raghunathpur, Po: Karadakana PS: Sheragada, Dist: Ganjam, Odisha do affirms
state on oaths as follows:
1. That, I am deponent of this affidavit.
2. That, my Kalicharan Satapathi S/o late Purastama Satapathy(Father), kumuduni
Satapathi of Village: Raghunathpur, Po: K Karadakana PS: Sheragada, Dist:
Ganjam, Odisha was born on dated: 01.01.2059 at our residence Raghunathpur
at 3.30 A.M.
3. That, due to ignorance I along with my family member’s could not intimate date
of Birth event of me, Births and Deaths Registrar of C.H.C Sheragada, Ganjam.
4. That, I have not receive the Birth Certificate from any authority of Odisha as
well as India.
5. That, I require it for forther further reference
6. That, I have never filed before the any authority for issuance of Birth Certificate
today.
7. That it is required for Non Availability certificate filing for Death certificate
before the concerned authority.
8. That, this affidavit is produced before the Authority Concern, Registrar Births
and Deaths, C.H.C Sheragada for his/her satisfaction and above information.
That, the facts stated above all are true to the best of my knowledge and belief.

Identified By
Deponent

Advocate