Jana Seba Kendra

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Guardianship Certificate

Checklists for Issuance of Guardianship Certificate

Here are list of Documents give any two of them

ଡକ୍ୟୁମେଣ୍ଟ ଗୁଡିକର ତାଲିକାରୁ ଆପଣ ଯେ କୌଣସି ଦୁଇଟି ଦେଇପାରିବେ

Guardianship Certificate Form (#17)

Personal Details

Enter our personal details

Salutation

First Name

Last Name

Gender

Marital Status

Age

Father Name

Mobile Number

Aadhar Number

Mother Name

Present Address

Present Address of Applicant

Address

Address Line 1

Address Line 2

City

State

Pin code

Country

Village

Ri Circle

Post Office

Tehsil

Police Station

Ward no and municipality if urban

Permanent Address

permanent address of applicant

Address

Address Line 1

Address Line 2

City

State

Pin code

Country

Village

Ri Circle

Police Station

Post Office

Ward no and municipality if urban

Family members/Guardian details (in case of minor and person unable to manage his/her own affairs):

who is applying

If any person other then applicant filling the Application ? *

Submitter’s Name ( In case Submitter is not the Applicant

Releation with Applicant

Purpose

Purpose for which certificate being applied for

Purpose

Legal Guardian ( Proposed )

Legal Guardian Details

Salutation

First Name

Last Name

Father Name

Age

District

Village

Pin Code

Tehsil

Police Station

City

Relation with the minor/person incapable of managing his/her own affairs

Please Specify

Declaration

Declarion

Declaration

I do hereby declare that the information given by me in this application form is true to the best of my knowledge and I have not suppressed / misrepresented any fact. That, I am solely responsible for the accuracy of the declaration and information furnished and shall be liable for action under section 199, 200 and 420 of Indian Penal Code and other relevant laws/ rules in case of furnishing wrong declaration and information. Also, I am well aware of the fact that the certificate shall be summarily cancelled and all the benefits availed by me shall be summarily withdrawn in case of furnishing wrong declaration and information.

Place

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