Sworn Affidavit Form (Sample)
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1S S S S W W W W O O O O R R R R N N N N A A A A F F F F F F F F I I I I D D D D A A A A V V V V I I I I T T T T
I, I, I, I, _______________________________
_______________________________
_______________________________
residing
residing
residing at at at at ___________________________________
___________________________________
___________________________________
_______________________________ residing
___________________________________
______________________
______________________
having
having
sworn
sworn
sworn in in in in accordance
accordance
accordance
with
with
local
local
law,
law,
do do
hereby
hereby
depose
depose
and
and
say:
say:
______________________
______________________ having
having sworn
accordance with
with local
local law,
law, do
do hereby
hereby depose
depose and
and say:
say:
1. 1. 1. 1.
that
that
that I I I I am
am
am
married
married
married 2 2 2 2 years
years
years
prior
prior
prior to to to to the
the
the
date
date
date of of of of submission
submission
submission
submission of of of of OCI
OCI
OCI
Application.
Application.
that
am married
years prior
the date
OCI Application.
Application.
2. 2. 2. 2.
that
that
that in in in in case
case
case
case of of of of dissolution
dissolution
dissolution
dissolution of of of of marriage,
marriage,
marriage,
marriage, I I I I will
will
will
notify
notify
and
and
return
return
the
the
OCI
OCI
Card
Card
Card to to to to the
the
the
Consulate.
Consulate.
that
will notify
notify and
and return
return the
the OCI
OCI Card
the Consulate.
Consulate.
3. 3. 3. 3.
that
that
that I I I I am
am
am
executing
executing
this
this
affidavit
affidavit
affidavit to to to to confirm
confirm
confirm
the
the
abovementioned
abovementioned
facts
facts
and
and
and in in in in support
support
support
support of of of of my
my
my
that
am executing
executing this
this affidavit
confirm the
the abovementioned
abovementioned facts
facts and
my
application
application
application
application for
for
for
for OCI
OCI
OCI
OCI Card
Card
Card
Card on
on on
on the
the
the
the basis
basis
basis
basis of of of of my
my
my
my spouse.
spouse.
spouse.
spouse.
I I I I hereby
hereby
hereby
declare
declare
that
that
the
the
above
above
particulars
particulars
are
are
true
true
and
and
agree
agree
that
that
that in in in in case
case
case
any
any
false
false
hereby declare
declare that
that the
the above
above particulars
particulars are
are true
true and
and agree
agree that
case any
any false
false
information
information
information
information is is is is given
given
given
given in in in in the
the
the
the affidavit,
affidavit,
affidavit,
affidavit, appropriate
appropriate
appropriate
appropriate action
action
action
action can
can
can
can be be be be taken
taken
taken
taken as as as as per
per
per
per Government
Government
Government
Government of of of of India
India
India
India Rules
Rules
Rules
Rules
and
and
and
and Regulations
Regulations
Regulations
Regulations against
against
against
against me
me
me
me including
including
including
including but
but
but
but not
not
not
not limited
limited
limited
limited to to to to revoking
revoking
revoking
revoking of of of of issue
issue
issue
issue of of of of OCI
OCI
OCI
OCI Card
Card
Card
Card including
including
including
including penalty
penalty
penalty
penalty
and
any
other
action
action as as as as deemed
deemed
deemed fit fit fit fit by by by by the
the
Government
Government of of of of India
India
India or or or or its its its its agencies.
agencies.
and
and
and any
any
any other
other
other action
action
deemed
the
the Government
Government
India
agencies.
agencies.
Applicant's
Applicant's
Applicant's
Applicant's
Spouse
Spouse
Spouse
Spouse
Signature
Signature
: : : : _______________________
_______________________
_______________________
Signature
Signature
: : : : _________________________
_________________________
_________________________
Signature
Signature
_______________________
Signature
Signature
_________________________
Name
Name
Name
Name
: : : : _______________________
_______________________
_______________________
_______________________
Name
Name
Name
Name
: : : : _________________________
_________________________
_________________________
_________________________
Passport
Passport
No.
No.
: : : : _______________________
_______________________
_______________________
Passport
Passport
No.
No.
: : : : _________________________
_________________________
_________________________
Passport
Passport No.
No.
_______________________
Passport
Passport No.
No.
_________________________
Date
Date
Date : : : :
: : : : _______________________
_______________________
_______________________
Date
Date
Date : : : :
: : : : _________________________
_________________________
_________________________
Date
_______________________
Date
_________________________
(SIGNATURES OF THE APPLICANT AND SPOUSE ARE TO BE ATTESTED BY THE NOTARY)
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