DATE of BIRTH AFFIDAVIT

I, Mahinder Kumar, applying through my mother and natural Guardian, Smt.

Raghurai wife of Sh. Haripal, resident of Chandpur, village Ahmedabad, katauli,
Lukhnow, UTTAR PRADESH, PIN 227111, do hereby solemnly declare and affirm as
under: 1. That my date of Birth is 15 August, 2004.
2. That I was born at village Ahmedabad, katauli, Lukhnow, Uttar Pradesh, INDIA.
3. That my mothers name is Smt. RAGHURAI .
4. That my father's name is Sh. Haripal .
5. That now I am resident of 184, Budhanpur, Panchkula (Haryana)
6. That I have no proof of my Birth date.

CHANDIGARH.

DEPONENT

DATED:
VERIFICATION:Verified that the contents of my above affidavit from are true and correct
to the best of my knowledge and belief. No part of it is false and nothing has been
concealed therein.
CHANDIGARH.
DATED:

DEPONENT
(Right Thumb impression)

Through mother and natural

Guardian
(Raghurai)