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Affidavit Sahara

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AFFIDAVIT

(Non-judicial stamp paper of Rs. 10 value)


(Affidavit certified by a Notary to be produced by Applicant for his/her name
mismatch between Aadhaar and Society’s FD Certificate/Pass-Book for the
purpose of Resubmission of Application on CRCS-Sahara Refund Portal
(Resubmission)Please type or Use Capital Letters for legibility while filling up
details)

Photo

I ………………………………. S/o/D/o/W/o .......................................... DoB ………………………


residing at …………………………………………. (Present address) and permanent address
…………………………….……………do solemnly affirm and state as under:
1. That I am the citizen of India.
2. That my name in Aadhaar is mentioned as …..………………..………………….
3. That I am a member of
Name of Society Membership Number
i)
ii)
iii)
iv)
4. That my name as in the FD Certificate(s)/RD Pass-Book(s) of the above
Society(ies) is mentioned as ………………….
5. I, hereby declare that above names pertain to one and same person i.e. the
Deponent being both the account holder and the member of the Society;
and for confirmation of above fact, I am attaching a self-attested copy of
my Photo ID i.e. Passport/ PAN Card/ Bank Pass Book/ Driving License/
EPIC (Voter Id Card)/ NREGA Job Card / Govt. or PSU-Employer’s ID
Card/ Proof of Marriage for e.g Marriage certificate or Wedding card with
wedding photo along with other PhotoID Card.
6. If any of the information given by me in the above is subsequently proven
to be incorrect or false, I hereby undertake to return the refunded amount
along with the applicable interest to ‘Sahara-CRCS Refund Account’ and
indemnify the “Sahara CRCS Refund Account’ to the said extent.

Signature
(Deponent)
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Verification

Verified and I solemnly state that the contents of this affidavit are true to
the best of my knowledge and belief and that nothing has been concealed
therein. Further, I shall also be liable for any civil or criminal action in
accordance with law, in case of any falsehood or misrepresentation.

Signature
(Deponent)
Place
Date:

Signature ofNotary Notary Seal

Name of theNotary

Registration ID No.

Address

Page 12 of 12

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