This Certificate serves to certify that Mr./Mrs.____________ is a owner or member of our society and resides in Flat No. ______. The following members of his/her family reside with them since ___/____/_______. Name
Relation
1. 2. 3. 4. This certificate is issued on the request of the member for the purpose of issuance of passport.
Signature Round Seal (Secretary /Joint Secretary /Chairman) Rubber Stamp