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Affidavit for Date of Birth Correction

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Title

Applicant Name

Relation *

Guardian's Name *

Age *

Address *

Record / Document *

Incorrect Date of Birth *

Correct Date of Birth *

Reason for Incorrect Entry

Proof Document

Verification Date

EDrafted

AFFIDAVIT FOR DATE OF BIRTH CORRECTION

I, Miss., S/o ____________, aged about ____________ years, R/o ____________, do hereby solemnly affirm and declare as under:

That my name is Miss. and I am a resident of the above-mentioned address.
That my Date of Birth has been wrongly recorded in ____________ as ____________.
That my correct Date of Birth is ____________.
That the incorrect Date of Birth was recorded due to ____________.
That ____________ is my true and correct Date of Birth as per ____________.
That I request the concerned authority to correct my Date of Birth in its records/documents from ____________ to ____________.
That this affidavit is being executed for submission before the concerned authority for correction of my Date of Birth.
That the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing material has been concealed.

VERIFICATION

I, Miss., the above-named deponent, do hereby verify that the contents of this affidavit are true and correct to my knowledge and belief.

Verified at ____________ on ____________.

DEPONENT

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