Necessary Enclosures related to above application are enclosed as under. (Please tick [ 9 ] for YES or tick [U] for NO) Yes/No Location Map of place [ ] Handicap Certificate for more than 50% [ ] True copies of Ration Card / Domicile Certificate / Voter ID [ ] NOC from Councilor of UMC regarding the location of the Booth [ ] Birth Certificate / School Leaving Certificate [ ] Below Poverty Line (BPL) Family Proof [ ] Affidavit regarding - "Applicant or his family has no other business in the Ulhasnagar city and has not benefited under the same scheme" [ ] Declaration I/We................................................................................................. state on solemn affirmation that the above information is true and correct to the best of my/our knowledge. If the information given is found wrong then I/We shall be held legally liable for its consequences. I/We am/are agreed to terms and conditions of corporation for above permission. Date:- Applicant's Signature ( ) The document may please be delivered to: 1. Self/Nominated Person [ ] a) C.F.C. [ ] b) Camp No. [ ] Name of Nominated Person (________________________________________________) 2. By Post a) U.P.C. [ ] b) Register A.D. [ ] 3. Courier [ ] (Not to be filled if address is same as above) Correspondence Address:- Father/Husband Name House/Building/Soc. Name: Wing/Floor: Road/Street/Lane: Taluka: Pin code: Email Address (if any):
