Before the Ld. Notary public at ………………(Name of Place)


                                                                        A F F I D A V I T



I, Sri. _______________, S/o _______________, aged about _____ years, ______(Religion name) by religion, Business by occupation, presently residing at ___________________________________(Address with pin code, Ward no, P.O and P.S, District and State) do hereby solemnly declare as affirm:-


  1. That I was born on ________ at ______(Birth Place)

  2. That as such my date of birth is _______ but I have no documentary evidence in support of my date of birth.

  3. That I am swearing this Affidavit to proof my date of birth for the purpose of inclusion of my name in voter list.

The Statement made above is true to my knowledge and belief and I sign this Affidavit on this _____(day) ______(month), _____ (year) at ______(Name of place).




                                                                                                                           D E P O N E N T


                                                                                                                            Identified by me:



                                                                                          Advocate, ________(Name of place).






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