Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697804390880.pdf (India)
SELF-DECLARATION Certified that I __________________________ or my spouse of Sh./Smt.

_________________________________ neither working in Central/State Government nor covered by ESI.

Place:________________ Date: ________________ Signature________________ (Grantee) Attested by: ____________________