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TO WHOM IT MAY CONCERN

Certificate of identity & Address


Fix photo
And
Attested with
Gazetted officer

I identify the person in Photo to be Mr/Mrs


S/o D/o W/o His/Her
Date of Birth a person known to me and
his/her current residential address is as given below:-

Residential Address:-
Flat/Door No. :
Road/Street :
Area/Locality :
Village/Town :
Mandal :
District :
Pin Code :
Mobile No :

Specimen Signature Authorised Signatory by Gazetted Officer


Name:
Designation:
Seal / Stamp:

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