I, Shri A B .C ,
age 35 years, occupation – service,
resident of 1250 Deccan Gymkhana, Pune 411 004, do hereby state on solemn affirmation as follows :

1. That was born at on

2. That I passed my SSC Examination from the Maharashtra State
Board of Secondary Education, Pune Division, in March

3. That I passed my HSC Examination from the Maharashtra State
Board of Higher Secondary Education, Pune Division, in March
4. That I was graduated from the University of Pune in the year
In the Faculty of Arts/Commerce/Science.

5. That I joined the Government service in the Public Works Department
as an Assistant, on ;

6. That I already completed the Diploma in Computer Technology
conducted by the Maharashtra State Board of Technical Examinations,
Mumbai, in the year

WHATEVER stated above is true and correct to the best of my knowledge and belief, and so I have signed hereunder at Pune this____day of 200_

Sd/- ABC
AFFIANT I know the Affiant.

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