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AFFIDAVIT

(Specimen of affidavit to be submitted by the applicant who will apply for


authentication of declaration of the newspaper/magazine/Journal on non-judicial
stamp paper of worth Rs.10/- duly attested by a Notary Public).
------------

I______________________son/daughter/wife_______________________
of
____________________presently
resident
_____________________of
_____________________
do solemnly affirm and declare as follows:-

1.

That I have applied for authentication of declaration as mentioned in my


enclosed

application.

It

will

be

language______________ periodicity.

published

in

_________________

To be published and printed at

________________________________________________.
2.

That the owner of newspaper/magazine/journal is___________ and he has


given his consent for this.

3.

That

my

permanent

is____________________________________________(proof

address
attach

duly

attested by serving G.O.).


4.

That I am not publishing other newspaper/magazine/journal.

(In case

publishing other newspaper/magazine/journal -- attach the list of other


publication with details.)
5.

That there is nothing against me to debar me from being publisher or printer.

6.

That I am also doing the following occupations other than this :


attach)

(Proof

(a)______________________________________________
(b)______________________________________________
(c)______________________________________________
7.

That the true and precise account of place publication is as under:______________________________________________________________


______________________________________________________________
______________________________________________________________
__________
and the place is not violating MPD 2021 and is in my legal possession.

8.

That other details of my publication is as under:-

i)

Office telephone No._____________________

Mobile No.______________

ii)

Residence telephone No.____________

Mobile No.______________

iii)

E-Mail ID_______________________.

9.

That the above mentioned title is not being used/published by any


Government/Semi Government Department.

10.

That the owner(s) of the Firm/Joint/Trust/Co-operative Society/Association


owing the newspaper/magazine is/are citizen(s) of India.

11.

That the owner (s) does/do not have any tie-up/collaborations with any
foreign organization nor any foreign funds/donations are involved in the
publication of newspaper/magazine.

12.

That the owner (s) will not have any tie-up/collaboration with any foreign
organization in future without the prior permission of the Government of India
in respect of the publication of the above mentioned newspaper/magazine.

13.

That I will not use this title for any other purposes other than as prescribed in
the Press and Registration of Books Act, 1867.

14.

That the identity cards issued to my employees will not use logos and colors
of the Delhi Police or any other Government agency, and I undertake that
these will be issued in the prescribed format only to genuine employee.

15.

That I will not print the name of Deputy Commissioner of Police, Licensing,
Delhi or any other Government Officer in any manner on identity cards which
will be issued by me to my employees.

16.

That

will

utilize

the

declaration

only

for

the

purpose

relating

publication/circulation of my newspaper/magazine/journal.
17.

That I will renew my Declaration Form [Form B] after three years.

to

18.

That in case I close the publication I will inform your office within 07 days of
its closing.

19.

That no child labour has been engaged/will be engaged to work for the said
publication.

20.

That no objectionable material or any other material, which is punishable


under IPC, will be published by me in my publication.

21.

That my annual income is Rs._______________(proof attached).

22.

That

my

nominee(s)

will

be_______________________

(relationship)

who

residing

is

my
at

_________________________________________________
_________________________________________________
23.

That I shall abide by the other guideline/directions given to me from your


office.

24.

That I shall abide by all the norms of Indian Law and existing Local Special
Law and other Law.
DEPONENT

VERIFICATION:

Verified

on__________________________day

______________________.

of

The particulars furnished by me are true and Correct to

the best of my knowledge and nothing has been concealed or misrepresented.

DEPONENT
ATTESTED

(Signature and Official Seal of Notary Public)