(TO BE PREPARED IN NON JUDICIAL PAPER WORTH RS 100)

AFFIDAVIT

I, Service No : ……………… Rank:…………. Name: ………………. , ………. years age,

Resident of ……………… House, PO: ……………….., Taluk: ………………,
……………….. Dist, ……………. State do solemnly affirm, state and declare as under:-

1. That I was enrolled in Army on …………….. and discharged from service with
effect from ……………….

2 That the child as per details given below has born to me and my wife ………………

Name of child Relationship Date of Birth Regn No & date Born at

………………….. …………………… ………………….. …………………… ………………………………

3. That this affidavit is sworn for publication of Birth of child by ………………Record

Office.

Signature of the Deponent

 VERIFICATION

1, the above said Service No: ……………… Rank: …………. Name: ………………….
do hereby solemnly affirm and declare that the facts mentioned above are
true to the best of my knowledge and belief and nothing has been concealed
thereof.

Dated and signed at ______________this the ________________day of

____________________2016.

Identified by

Advocate Signature of Deponent

The above deponent, who has been identified by the

Advocate_______________________________________, has solemnly affirmed
and signed before me at my office on this_____________ day of
________________2016.

ATTESTATION BY FIRST CLASS JUDICIAL MAGISTRATE

 REGISTERED
From,
………………………………………………….

……………………………………......
……………………………………….
Ref No: ……………………………….
Dated: ………………………………...
To,

The Officer in Charge

……………………………..
……………………………..

Through Zila Sainik Welfare Office………………………,

Sir,
SUB: REQUEST FOR PUBLICATION OF PART II ORDER: BIRTH OF CHILD

1. I was discharged from service wef ………………………. My daughter/son ……………………… has

born on …………………. after my discharge from service. Due to my ignorance and not aware of the
procedures, I could not submit the documents for publication of Part II Order. I request you to
condone the delay and publish Part II Order for birth of my Child. The particulars are as under:-
Marriage/Re Marriage/ Details
Service No, Rank, Name: ……………………………………………..
Date of Enrolment: …………………………………………….
Date of Discharge: …………………………………………….
Name of Wife: …………………………………………….
Place of Marriage: NA
Date of Marriage: NA
Details of Child / Children
Name of Child: ………………………………………………
Male/Female: ………………………………………………
Date of Birth: ………………………………………………
Place of Birth: …………………………………………..
2. I request an early action, I request you to return the Original Birth Certificate.
Yours faithfully,

(……………………………………………)
Encl:
1) Personal Application
2) Affidavit sworn before First Class Judicial Magistrate
3) Original Birth Certificate & Attested copy by Zila Sainik Welfare Office
4) Attested copy of Secondary School Leaving Certificate
REGISTERED
 From,
………………………………………………….

……………………………………......
……………………………………….
……………………………………….
Ref No: ……………………………….
Dated: ………………………………...

To,

The Officer in Charge

……………………………..
……………………………..

Sir,
SUB: REQUEST FOR PUBLICATION OF PART II ORDER: BIRTH OF CHILD

1. I was discharged from service wef ………………………. My daughter ……………………… has born
on …………………. after my discharge from service. Due to my ignorance and not aware of the
procedures, I could not submit the documents for publication of Part II Order. I request you to
condone the delay and publish Part II Order for birth of my Child.

Yours faithfully

(……………………………………….)