I ______Son/Daughter/Wife of ______ Resident of _______
District____ do hereby solemnly affirm and declare as follows:
1. That I am citizen of _________.
2. That my permanent residence is ________District______
3. That I am Continuous residing in _________ state for the at
least last _________ years.
4. That my Place & Date of Birth is _________ & _________.
5. That I have never obtained a domicile certificate from any
6. That I am giving _________ documents as proof for applying
Domicile in _________.
7. That I am obtaining Domicile Certificate for _________.
Verified at _________ on this _________ day of _________,
_________ that the contents of this affidavit are true and correct
to the best of my knowledge and belief and nothing has been