DECLARATION FORM - IIT Kanpur

DECLARATION FORMI, _____ hereby declare that following are the members of myfamily who are residing with me and are wholly dependent upon OF MEMBERS OF FAMILY:Sl. in FullDate of BirthRelationshipThe particulars of dependent members of my family as given above are correct. If any statement is found tobe untrue I shall be liable for disciplinary action. _____ (Signature of student)Name: _____Roll No. :_____House No.:_____Date:_____Forwarded_____(Signat ure of the Head)(with Seal)

DECLARATION FORM I, _____ hereby declare that following are the members of my family who are residing with me and are wholly dependent upon me.

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Transcription of DECLARATION FORM - IIT Kanpur

1 DECLARATION FORMI, _____ hereby declare that following are the members of myfamily who are residing with me and are wholly dependent upon OF MEMBERS OF FAMILY:Sl. in FullDate of BirthRelationshipThe particulars of dependent members of my family as given above are correct. If any statement is found tobe untrue I shall be liable for disciplinary action. _____ (Signature of student)Name: _____Roll No. :_____House No.:_____Date:_____Forwarded_____(Signat ure of the Head)(with Seal)