AFFIDAVIT

I Shri/ Smti/ Kum……………………………………………...................................

S/o/W/o/D/o……….…………………………………………………………….,age….........

years Permanent R/o(Village)………....................…….P.O…………………................

District………………………...………State………………………………………...............

I solemnly declare that the information submitted to the General Manager, District
Industries Centre / RJD, Chennai is correct in all respect up to the best of my knowledge and
belief.

FURTHER I DECLARE THAT:-

1. I am a prominent person of the society and at present there is no liability pending

against me for any Government Department/Co-operative Society and
individual firms as well as there is no any trial pending or under consideration with crime or
fraud.

2. I am applying for Amma Skill Training & Employment Scheme implemented by the
District Industries Centre / RJD, Chennai.

3. I will abide completely by the rules and regulations laid down under the Amma Skill
Training & Employment Scheme.

(DEPONENT)

Signature
Witness. (Name & Address)

1.

2.
 Form-II
Application Format for Candidate
AMMA SKILL TRAINING & EMPLOYMENT SCHEME

1. Name :

Applicant’s
passport
size photo
2. Address for Communication :
3. Date of Birth :
4. Gender : Male/Female
5. Aadhar Id No. :
6. Community /Religion :
7. Educational Qualification :
8. Mobile no. :
9. Email Id :
10. Willing to undergo training in :

I hereby confirm that the above information furnished is true to the best of my
knowledge and belief.

Signature of the Candidates

LIST OF DOCUMENTS TO BE ENCLOSED:-

1. Copy of the Qualification Certificate

2. Copy of the Age proof certificate( Either TC or SSLC Mark sheet)

3. Copy of the Residential Certificate (Like Ration Card / Aadhar Card)

4. Copy of the Community Certificate

5. Copy of the Affidavit