DECLARATION

(To be furnished by the applicant for appointment as SAS / MPKBY Agent alongwith the application)
I, ................................... (CANo. .....................................   S/o and D/o ................................................... resident of ......................... ............ .................... ............................... ...................... solemnly affirm as under:-
  1. That I am not an employee of the State Government / Central Government and Union Territory and undertake to inform the appointing authority and give up the agency whenever I enter such employment.

  2. That none of my near relative is working in the Postal Department, in a non-gazetted capacity in the same Division where the agency falls.

  3. That none of my near relative who is dependant on me is working in the Postal Department, in a non-gazetted capacity in the State of Tamil Nadu.

  4. That none of my near relative is working in the National Savings Organisation in the State of Tamil Nadu.

  5. That none of my near relatives is working in the Postal Department National Saving Organisation in a Gazetted capacity any where in India.

  6. That I would apply for my renewal of agency in 45 days in advance.

  7. That I would procure business myself.

  8. That I would not sit in the Post Office, If I am found without any business in the Post Office, My Agency may be terminated.

  9. I further declare that none of my near relatives (i.e. my wife/husband, legitimate child or step child, father/step father, mother/step mother, brother/step brother, sister/step sister, father in law, mother in law, brother in law, sister-in-law or daughter in law) is employed under the Central or State / Union Territory Government.


                                                                          OR

  10. I give below the particulars of my near relatives (i.e. my wife / husband, legitimate child or step child, father / step father, mother / step mother, brother / step brother, sister/ step sister, father-in-law , mother-in-law, brother-in-law, sister-in-law, son-in-law or daughter in law) who are employed under the Central or State / Union territory Government.
Sl. No. Name of relative Relationship with the applicant Name and address of office where employed


  2. .


I attach the communication(s) in original from the Head(s) of Office / Department where the above mentioned person(s) is/are employed to the effect that there is no objection to my being appointed as Agent under the Standardised Agency System / Mahila Pradhan Kshetriya Bachat Yojana.

DEPONENT
I verify that the affirmations made by me as above are correct to the best of my knowledge and belief and that no material facts have been concealed be me.

DEPONENT
Signed in my presence:
Witnesses:
1.

 

 2.
Name & Address

 

Signature

 Name & Address


Signature