Kaagazaat

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Old Age / Widow Pension Affidavit

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  1. You, the applicant
  2. The pension and your eligibility
  3. Filing and signing

Step 1 of 3

You, the applicant

Where you are ordinarily residentNeeded

For example: Gurdial Kaur

For example: widow of Late Sh. Baldev Singh

A plain number. Digits only — no words and no units beside them.

For example: 67

A calendar date — the day, the month and the year. Dates in a document like this are read against one another, so a date typed here can change what another date is allowed to be.

Your addressNeeded

For example: 4444 5555 6666

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OLD AGE / WIDOW PENSION AFFIDAVIT

Executed at __________ on __________.

I, __________, __________, aged about __________ years (date of birth __________), resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

  1. SCHEME APPLIED FOR

1.1 I am applying for __________, and I make this affidavit in support of that application for filing before __________.

  1. RESIDENCE AND ELIGIBILITY

2.1 I have been ordinarily resident within __________ for __________ years, and I continue to be ordinarily resident there as on the date of this affidavit.

2.2 My total annual family income, from all sources, is __________.

2.3 __________

  1. BANK ACCOUNT FOR DIRECT BENEFIT TRANSFER

3.1 The pension, if sanctioned, may be credited to the following account, which stands in my own name: __________

  1. DECLARATION

4.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to my eligibility for __________.

4.2 I am aware that this is a means-tested welfare benefit, that its continuance depends on the facts stated above remaining true, that I must report in writing to __________ any change in my income, any remarriage where this is a widow's pension, any other pension I come to receive, or any change of residence, that a benefit drawn on a false statement is recoverable, and that making a false declaration in a sworn affidavit is an offence.

VERIFICATION

Verified at __________ on __________ that the contents of paragraphs 1 to 4 above are true and correct to my own knowledge, that no part of it is false, and that nothing material has been concealed.

DEPONENT

Signature: ______________________________
__________

Left thumb impression (if unable to sign): ____________

ATTESTATION

Solemnly affirmed and signed before me on __________ at __________, the Deponent having been identified to my satisfaction by __________.

Notary Public / Oath Commissioner
Registration No. and seal: ____________________

The rest stays out of view until every answer is in.

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OLD AGE / WIDOW PENSION AFFIDAVIT

Executed at __________ on __________.

I, __________, __________, aged about __________ years (date of birth __________), resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

  1. SCHEME APPLIED FOR

1.1 I am applying for __________, and I make this affidavit in support of that application for filing before __________.

  1. RESIDENCE AND ELIGIBILITY

2.1 I have been ordinarily resident within __________ for __________ years, and I continue to be ordinarily resident there as on the date of this affidavit.

2.2 My total annual family income, from all sources, is __________.

2.3 __________

  1. BANK ACCOUNT FOR DIRECT BENEFIT TRANSFER

3.1 The pension, if sanctioned, may be credited to the following account, which stands in my own name: __________

  1. DECLARATION

4.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to my eligibility for __________.

4.2 I am aware that this is a means-tested welfare benefit, that its continuance depends on the facts stated above remaining true, that I must report in writing to __________ any change in my income, any remarriage where this is a widow's pension, any other pension I come to receive, or any change of residence, that a benefit drawn on a false statement is recoverable, and that making a false declaration in a sworn affidavit is an offence.

VERIFICATION

Verified at __________ on __________ that the contents of paragraphs 1 to 4 above are true and correct to my own knowledge, that no part of it is false, and that nothing material has been concealed.

DEPONENT

Signature: ______________________________
__________

Left thumb impression (if unable to sign): ____________

ATTESTATION

Solemnly affirmed and signed before me on __________ at __________, the Deponent having been identified to my satisfaction by __________.

Notary Public / Oath Commissioner
Registration No. and seal: ____________________

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