I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:
1. CASTE AND CATEGORY
2. PARENTS AND THEIR SERVICE
3. FAMILY INCOME
3.3 To the best of my knowledge and belief, neither I nor my parents fall within any category of persons treated as the "creamy layer" under the instructions that apply to the purpose stated in paragraph 4, and I ask to be treated as belonging to the Non-Creamy Layer.
4. PURPOSE
4.2 I undertake to inform the issuing authority if my family's income or my parents' service status changes materially before the certificate is issued, and I understand that the certificate may be withheld or cancelled if any statement made here is found false.
5. DECLARATION
5.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to this application. I am aware that making a false declaration in an affidavit is an offence.