FAMILY ID (PARIVAR PEHCHAN PATRA) INCOME / MEMBER CORRECTION SELF-DECLARATION
Executed at __________ on __________.
I, __________, __________, resident of __________, holding Aadhaar number __________, the head of family or an authorised adult member recorded against Family ID __________ (the "Deponent" or "I"), do hereby solemnly declare as follows:
- THE CORRECTION SOUGHT
1.1 __________ is required in the Family ID / Parivar Pehchan Patra record identified above.
- SUPPORTING DOCUMENT
2.1 In support of the correction declared above, I rely on and am submitting: __________
- HOW THIS DECLARATION IS BEING FILED
3.1 I am submitting this declaration, together with the supporting document referred to above, __________.
- DECLARATION
4.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to this correction. I make this declaration on behalf of the family recorded against the Family ID stated above, with the knowledge and consent of its adult members.
4.2 I am aware that the Citizen Resources Information Department, Government of Haryana verifies a correction of this kind against its own records and the supporting document before approving it, that the request may be referred to a local verifier before approval, and that furnishing false information in connection with the Family ID / Parivar Pehchan Patra database may lead to rejection of this request and to such other action as the Department finds appropriate.
VERIFICATION
Verified at __________ on __________ that the contents of paragraphs 1 to 4 above are true and correct to my own knowledge, and that nothing material has been concealed.
DEPONENT
Signature: ______________________________
__________