FORM V
AFFIDAVIT
(Note: To be executed before a competent Magistrate on a judicial stamp of Rs. 20/-)
I, Shri/Smt./Kum.______________________________________________son/wife/daughter of
______________________________________do hereby solemnly affirm and state as under:-
1. That I have applied for allotment of a plot at ___________________________
_______________________________________________________from goa Housing Board under General/Reserved category of______________________.
2. That neither myself nor any other member of my family own a plot of land or any other dwelling unit or tenement under the Housing Board Scheme anywhere in the State of Goa.
I, further affirm that what is stated hereinbefore is true to my own knowledge and belief and I know that to make a false affidavit is an offence.
Deponent