Annexure I

THE AFFIDAVIT (for Hindi Linguistic Minority Qu ota only)

(To be typed on Rs.100/- Stamp Paper)
THE Registered Notarized AFFIDAVIT FOR CANDIDATES
I, Mr./Ms. aged years Indian Inhabitant
(Name of Candidate)
of residence
(City and State) (Native Place address)
do hereby state and declare on solemn affirmation as under:
I say that / I was born on
(Name of Candidate) (Date of birth)
and since then I am pennanently residing at
(Place of Birth) (Current address Mumbai)
say that my family members belong
to Hindi Linguistic Minority community by birth.

I say that I belong to Hindi Linguistic Minority

(Name of Candidate)
Community by Birth and caste. Following documents enclosed for confirmation of Hindi Linguistic
Minority Community.
I am submitting the following documents as proof for my eligibility for Hindi Linguistic Minority as per
mentioned in the Admission Form.

1) Registered Notarized Affidavit on Stamp paper of Rs.L00/- as per format available in

College office for Hindi Linguistic Minority.
2) Certificate issued on college/ School letter head by PrincipaUHead Master of Junior
College/Iligher School for Mother Language (As per as prescribed format Annexure
6(II" (Mandatory)

I am making this affidavit in order to produce before the concerned authorities i.e. Smt.
Kamaladevi G. Mittal Punarvasu Ayurved Mahavidyalaya, Mumbai to enable me to get the admission
in 1't B.A.M.S. in Smt. Kamaladevi G. Mittal Punarvasu Ayurved Mahavidyalaya,tvtumUai under Hindi
Linsuistic Minoritv quota
'Whatever
stated hereinabove is true and correct to the best of my knowledge and belief. If
any entry/information found falser l shall be liahle for cancellation of my admissioo ulong witt penal
action to be taken as per law at my own responsibility.

Solemnly affirmed at on this ZO1g. \

(Place of affidavit) (Date of affidavit)
Deponent

Before me

(Signature of the Notary/Magistrate

Along with Registration number)