Power Of Attorney

Myself Seema Sewda D/O Sohan Lal Sewda, Passport no. T7688973
Passport's date of issue.02/08/2019 and date of expiry is 01/08/2029,
resident of Bosana, Teh. Dhod, Dist. Sikar , Rajasthan, INDIA Pin.
332025. I am student of 2nd year International Medical Faculty, osh
state university, osh kyrgyzstan. I am applying for my visa extension. I
am still in India. I can't be there for taking my Non- criminal certificate
from Department of internal affairs Osh state Kyrgyzstan and doing
other documentation.
So I am authorising Mr. Firoz Hussain S/O Zakir Hussain Passport no.
Z4585686, Resident of H/NO- 466, Jhagrarpar Part-1, Jhagrarpar,
Dhubri, Assam, INDIA Pin no. 783325, Student of 6th year
International Medical Faculty, Osh state university, Osh Kyrgyzstan. to
take my Non- criminal certificate from department of internal affairs
Osh state Kyrgyzstan and for doing other documentation.

Witness Deponent
 AFFIDAVIT
I------------------------------------------------W/O----------------------------------------Permanent R/O
Village-------------------------------P.O----------------------Distt--------------------State------------------------------------I
solemnly declared that the information submitted to KVIC/KVIB/DIC is correct in all respect up to the hest
of my knowledge and belief Further declare that: -
1- I am prominent person of the society and at present there is on liability pending against me for any
Govt. Department/co-operative society and individual firms a well as there in no any trial pending
or under consideration with crime or fraud.
2- I am not in Govt. Service.
3- I am applying for loan under PMEGP scheme.
4- I will set up the unit in the rural area certified by the revenue department in the
village----------------------------Po------------------------------------Tehsil
----------------------------------------------Distt-----------------------------------State
------------------------------------------------------------.
5- I will setup a new unit after getting loan from bank under PMEGP and will not manipulate in any
respect with old units.
6- I will abide completely by the rules and regulations laid down under PMEGP scheme.
7- I will allow and co-operative the Govt. officials to inspect my unit installed under PMEGP have
full authority to recover the margin money with interest .
8- I will use the loan amount under PMEGP for setting up the unit for which it is taken and will not
mish-utilize it.
9- I will submit the progress report of the unit setup under PMEGP scheme to KVIC/RKVIB/DIC as
the case may be regularly in time without fail.
10- Myself or any of my responsible for any type of mystification of the loan under PMEGP scheme.
11- Myself or any my family members have not availed any finical assistance under PMEGP, REGP,
PMRY or any other scheme of Govt. of India or state Government scheme.
12- I have not availed/applied for any subside from any other Department for the proposed unit.

Witness- DEPONENT
1-

2- Signature
 AFFIDAVIT
I------------------------------------------------W/O----------------------------------------Permanent R/O
Village-------------------------------P.O----------------------Distt--------------------State------------------------------------I
solemnly declared that the information submitted to KVIC/KVIB/DIC is correct in all respect up to the hest
of my knowledge and belief Further declare that: -
1- I am prominent person of the society and at present there is on liability pending against me for any
Govt. Department/co-operative society and individual firms a well as there in no any trial pending
or under consideration with crime or fraud.
2- I am not in Govt. Service.
3- I am applying for loan under PMEGP scheme.
4- I will set up the unit in the rural area certified by the revenue department in the
village----------------------------Po------------------------------------Tehsil
----------------------------------------------Distt-----------------------------------State
------------------------------------------------------------.
5- I will setup a new unit after getting loan from bank under PMEGP and will not manipulate in any
respect with old units.
6- I will abide completely by the rules and regulations laid down under PMEGP scheme.
----2-----
 (2)
7- I will allow and co-operative the Govt. officials to inspect my unit installed under PMEGP have
full authority to recover the margin money with interest .
8- I will use the loan amount under PMEGP for setting up the unit for which it is taken and will not
mish-utilize it.
9- I will submit the progress report of the unit setup under PMEGP scheme to KVIC/RKVIB/DIC as
the case may be regularly in time without fail.
10- Myself or any of my responsible for any type of mystification of the loan under PMEGP scheme.
11- Myself or any my family members have not availed any finical assistance under PMEGP, REGP,
PMRY or any other scheme of Govt. of India or state Government scheme.
12- I have not availed/applied for any subside from any other Department for the proposed unit.

Witness- DEPONENT
1-

2- Signature
 AFFIDAVIT
I------------------------------------------------Director/Proprietor of M/s---------------------------------
Location-------------------------Aged--------Resident of -----------------------P.O----------------------
Distt--------------------State---------------do hereby under taking on oath as follows:-
1- That this Consent to Establish is being obtained for manufacturing of
_________________________up to ____________________in case of any increase in
capital or addition/modification/alteration or change in process or raw material, we will
obtain fresh Consent to Establish.
2- That the plot area of the unit is ___________________Sq. Mtrs.
3- That the number of workers proposed to carry out various activities in the unit will be
workers.
4- That the total number of employees in the unit will be _____ person.
5- That the total capital investment on the project will be Rupees ______ Lacs.
6- That no trade effluent shall be generated from any of the processes.
7- That the production including the trial production shall not be undertaken until and
unless
(a) all the conditions which may be set out in grant of consent to establish are complied
with
(b) Consent to operate, both under Air (Prevention & Control of Pollution) Act-1981 and
Water (Prevention & Control of Pollution) Act- 1974 are obtained.
8- That all adequate measure to control water/ air pollution from the various processes/
activity treatment will be taken to meet the prescribed standards as per the Environment
(Protection) Rules, 1986 as amended to date.
9- That for the Diesel Generate Set (s) (of capacity__________KVA) acoustic
enclosure/acoustic treatment will be provide to meet the prescribed norms w.r.t noise as
per the Gazette Notification of Ministry of Environment & Forests, Government of India.
Dated 02/01/99. Adequate stack height with D.G. Set(s) shall also be provided and
maintained.
10- That the cost of proposed pollution control measures has already been included in the
project report which amounts to Rs. ....................And shall only be used for pollution
control measures.
11- That the proposed industry is small/medium/large scale unit with SSI registration
No.....................................dated.........................................................
12- That all orders, direction and standards laid down by the Board, from time to time, shall
be complied with.
13- That the name and address of the Managing Director and other Directors are given
hereunder. Any change there of shall be intimated forthwith to the State Board.

DEPONENT
VERIFICATION
Verified at----------------------on this----------------------(day, month and Year), that the above
contents of this affidavit are true and correct to the best of my Knowledge and belief and noting
has been concealed there from.

DEPONENT
 AFFIDAVIT
I , Mr. MANOJ KUMAR Caste JAT Sub Caste JINJWARDIYA Religion HINDU Of
Village MAGANPURA Post MOTA KI DHANI Teh DANTA RAMGARH Distt SIKAR
(RAJ.) to hereby solemnly that declare as under:-
(a) That my father's Name Is:- GANPAT SINGH
(b) That my Mother's Nmae Is:- JHAMARI DEVI
(c) That I have not been a member of any banned/political organization and has never
been in custody/jail and no criminal or judicial case is pending against me in any
Court of law in India/abroad.
(d) That I have not been convicted for any offence under the law.
(e) That I am married/unmarried. (I got married on................................................)

Signature................................
Verification:-

I, The above name deponent further a solemnly affirm and declare that whatsoever is
stated in this affidavit is true and correct to the best of my knowledge and believed and
nothing has been concealed therein. If the same is found incorrect I shall be liable for
disciplinary action as per the law.
With Round seal
Place
Date
 AGREEMENT
Am agreement on This-------------------------------------day of-------------------------------2011
Between M/s Rajendra tredras, Khachriyawas Dist. Sikar Raj. at the one party and the
super intemding Engginer (SC) sikar (herein a called the nigam) of the other party.
WHERAS the name of agreement M/s Rajendra Tradras Khachriyawas Dist.
Sikar has Regarding lab-our rate contract on CLRC Jan-2011 for the work of operation
and maintenance of 33/11 kv S/S under O&M sub division, Danta Ramgarh.
Now is the here by agreed between the here to:-
The agreement made of the terms and condition which are given the order No.
AVVNL/SE(SC)/Sik/TA/PS/F 2528 date 27/07/2011 page No. 1 to 8(Trems & conditions)
(Technical/Commercial/Gen.)

Superintending Engineer (O&M) M/s Rajendra Treaders

AVNNL, Sikar (Raj.) Khachriyawas Distt- Sikar
 AFFIDAVIT
I------------------------------------------------W/O----------------------------------------Permanent R/O
Village-------------------------------P.O----------------------Distt--------------------State------------------------------------ I
solemnly declared that the information submitted to KVIC/KVIB/DIC is correct in all respect up to the hest
of my knowledge and belief Further declare that: -
1- I am prominent person of the society and at present there is on liability pending against me for any
Govt. Department/co-operative society and individual firms a well as there in no any trial pending
or under consideration with crime or fraud.
2- I am not in Govt. Service.
3- I am applying for loan under PMEGP scheme.
4- I will set up the unit in the rural area certified by the revenue department in the
village----------------------------Po------------------------------------Tehsil
----------------------------------------------Distt-----------------------------------State
------------------------------------------------------------.
5- I will setup a new unit after getting loan from bank under PMEGP and will not manipulate in any
respect with old units.
6- I will abide completely by the rules and regulations laid down under PMEGP scheme.
7- I will allow and co-operative the Govt. officials to inspect my unit installed under PMEGP have
full authority to recover the margin money with interest .
8- I will use the loan amount under PMEGP for setting up the unit for which it is taken and will not
mish-utilize it.
9- I will submit the progress report of the unit setup under PMEGP scheme to KVIC/RKVIB/DIC as
the case may be regularly in time without fail.
10- Myself or any of my responsible for any type of mystification of the loan under PMEGP scheme.
11- Myself or any my family members have not availed any finical assistance under PMEGP, REGP,
PMRY or any other scheme of Govt. of India or state Government scheme.
12- I have not availed/applied for any subside from any other Department for the proposed unit.

Witness- DEPONENT
1-

Signature
2-
 AFFIDAVIT CUM UNDERTAKING
I------------------(Name of the candidate) s/o,D/o------------
age-----year,R/O Village----------------P.O---------------
Distt----------State-----------hereby under oath do as under:-
1- That I have obtained rank __________in the overall merit and
rank_________in my category merit of_________(category) and
rank_____________in my additional category merit of
_________(additional category) and am otherwise fully
eligible to be granted admission in the M.B.B.S./B.D.S.
course at NIMS Medical College/ NIMS Dental College, a
constituent college of NIMS University Rajasthan, Jaipur.
2- That I have been informed that the issue of conducting of
entrance examination for the above mentioned college and
admission of students to the same through RPMT- Jaipur. I
have further been informed that my Rajasthan High Court,
Jaipur. I have further been informed that my admission to
the NIMS Medical College/ NIMS Dental College, is subject to
final outcome of the writ petition pending before the
Hon'ble Rajasthan High Court and I undertake to abide by the
final order of the same which may entail cancellation of my
admission.
3- I further undertake to fulfill all the norms of eligibility
for admission to the course as stipulated by the MCI/DCI as
well as the norms, guidelines, statutes, ordinances, etc. of
NIMS University Rajasthan, Jaipur.

DEPONENT
VERIFCATION
I, the above named deponent, do hereby verify that the contents
of Paras No. 1 to 3 of my above affidavit are true and correct.
Nothing material has been concealed therein and no part of it is
false, So help me God.

DEPONENT
 DRAFT INDEMNITY BOND
This indemnity bond is executed on this-----------day of
January.2011, at jaipur by Shri---------------------(name, age,
address of LOI holder/dealer-select), hereafter called as
Execution (which expression shall include his successor, legal
Marketing Division---------------(full description) hereafter
called as Indemnity Holder(which expression shall include its
successors ,legal representative etc) as under:
1. Whereas M/S IOCL has issued LOI dated----------in favor of
execution for the above location/Execution is selected as
dealer -select as per the merit list dated----------for the
above location.
2. Whereas executants is also aware that Hon'ble Rajas than
High court, Jodhpur, has passed an order dated 11.11.2010
in SBCWP No.-------/2010 (Rajas than Petroleum Dealers
Association Vs- Union of India & others) to the effect that
installation of new retail outlets are subject to final
outcome of this writ petition.
3. Whereas executants is also aware that M/S IOCL/indemnity
holder is required to invest substantial amount of
Rs........in developing the mew retail outlet which
includes providing land, sales room, driveway, canopy,
dispensing pumps, underground tanks etc(as applicable).
4. Whereas executants is also fully aware that in case above
mentioned writ petition is allowed by Hon'ble High Court,
 then in that case, the subject retail outlet developed in
favor of executants, would be required to be closed
----2---

(2)
which would result into monetary losses to M/S Indian Oil
Corporation Ltd. In such circumvents executant's would not
be entitled nor M/S IOCL would be liable for any
compensation.
5. Whereas considering all the above facts in its totality
executants has requested M/S IOCL/Indemnity holder since he
is ready to make good the losses that would be suffered by
M/S IOCL/Indemnity holder And executants is ready to give
such undertaking/indemnity bond to the satisfaction of M/S
Indian Oil Corporation Ltd.
6. Hence this indemnity bond is executed by the above named
executants that in the event M/S IOCL is required to close
the retail outlet as a result of and in pursuant to
judgment of Hon'ble Rajas than High Court, Jodhpur, in the
 above mentioned writ petition, the executants would make
good the losses suffered by M/S IOCL/indemnity holder i.e.
Rs-------------------and if executants fails to the same in
spite of notice, M/S IOCL/indemnity holder would recover
the same through court of law .

Hence this indemnity bond.

Jaipur
Dated: Signature
(LOI holder/Dealer-select)
Witnesses:
1.

2.
LETTER TO BE TENDERED BY LOI HOLDER/SELECTED
CANDIDATE
Dear sir,
Sub: Issue of LOI
1. You are aware that your corporation has issued LOI
dated------------in my favor for the above location/ I have
been selected as per the merit list dated 06.08.2010.
2. I am also aware that Hon'ble Rajas than High court, Jodhpur
has passed an order dated 11.11.2010 in SBCWP
No.-------/2010 (Rajas than Petroleum Dealers Association
Vs--------Union of India & others)to the effect that
installation of new retail outlets are subjects to final
outcome of this writ petition.
3. I am also aware that oil companies are required to invest
substantial amount in developing the new retail outlet
which includes providing land, sales room, driveway,
canopy, dispensing pumps, underground tanks etc.
4. I am also fully aware that in case above-mentioned writ
petition is allowed by Hon'ble High Court, then in that
case, the subject retail outlet developed in my favor would
be required to be closed which would result into monetary
loss to M/S Indian Oil Corporation Ltd. In such
circumstances, I would not be entitled nor M/S IOCL would
be liable for, any compensation.
5. Considering all the above facts in its totality, I still
request M/S Indian Oil Corporation Ltd since I am ready to
 make good the losses that would be suffered by M/S Indian
Oil Corporation Ltd. and I am ready to give such
undertaking/indemnity bond to the satisfaction of M/S
Indian Oil Corporation Ltd.
You are, therefore requested to kindly issue letter of Intent in
may favor/take further steps towards commissioning of the
dealership.

Thanking You.

Yours faithfully
(Dealer-Selected/LOI holder)
 AFFIDAVIT
I------------------------------------------------W/O----------------------------------------Permanent
R/O Village-------------------------------P.O----------------------Distt--------------------
State------------------------------------ I solemnly declared that the information submitted to
KVIC/KVIB/DIC is correct in all respect up to the hest of my knowledge and belief
Further declare that :-
1- I am prominent person of the society and at present there is on liability pending
against me for any Govt. Department/co-operative society and individual firms a
well as there in no any trial pending or inder consideration with crime or fraud.
2- I am not in Govt. Service.
3- I am applying for loan under PMEGP scheme.
4- I will set up the unit in the rural area certified by the revenue department in the
village----------------------------Po------------------------------------Tehsil
----------------------------------------------Distt-----------------------------------State
------------------------------------------------------------.
5- I will setup a new unit after getting loan from bank under PMEGP and will not
manipulate in any respect with old units .
6- I will abide completely by the rules and regulations laid down under PMEGP
scheme.
7- I will allow and co-operative the Govt. officials to inspect my unit installed under
PMEGP have full authority to recover the margin money with interest .
8- I will use the loan amount under PMEGP for setting up the unit for which it is
taken and will not mis-utilize it.
9- I will submit the progress report of the unit setup under PMEGP scheme to
KVIC/RKVIB/DIC as the case may be regularly in time without fail.
10- Myself or any of my responsible for any type of misutilisation of the loan under
PMEGP scheme.
11- Myself or any my family members have not availed any finical assistance under
REGP PMRY or any other scheme of Govt. of India or state Government scheme.
12- I have not availed/applied for any subside from any other Department for the
proposed unit.
Witness- DEPONENT
1-
Signature
2-
Annexure "A"

OFFICE OF THE TEHSILDAR CERTIFICATE

This is to certify that

Shri/Smt.-----------------------------S/O. or
D/O--------------------------
Resides------------------------------at--------------
His/her annual gross family income from all sources
for the year-----is Rs------------(Rs--------------)
This certificate is issued for the purpose of claiming
Interest subsidy under the scheme of the Ministry of
HRD, Government of India for pursuing approved courses
of studies in Technical & Professional streams from
recognized institutions for his son/daughter
Mr./Ms-----------------------------------------------
The signature of Shri/Smt-----------------------is
attested here below.
Signature ------------------------
Place:
Date: Signature of Tehsildar
Name:
Seal
To whom sower it many concern
Shri Nemi chand saini is a customer
of this bank institution for last
Ten years and he is enjoying
following facilities of our Bank
(a) saving Bank A/C ----------------
(b) Fixed Deposit ------------------
During the above period the
dealing of Shri Nemi chand with the
bank and his conduct has been
satisfactory Incase a dealership is
allotted to him we will he willing
to extend a loan of your need base
after fulfilling all banks norms.
 AFFIDAVIT
I------------------------------------------------Director/Proprietor of
M/s---------------------------------Location-------------------------Aged--------Resident of
-----------------------P.O----------------------Distt--------------------State---------------do hereby
under taking on oath as follows:-
1- That this Consent to Establish is being obtained for manufacturing of
_________________________up to ____________________in case of any increase
in capital or addition/modification/alteration or change in process or raw material,
we will obtain fresh Consent to Establish.
2- That the plot area of the unit is ___________________Sq. Mtrs.
3- That the number of workers proposed to carry out various activities in the unit
will be workers.
4- That the total number of employees in the unit will be _____ person.
5- That the total capital investment on the project will be Rupees ______ Lacs.
6- That no trade effluent shall be generated from any of the processes.
7- That the production including the trial production shall not be undertaken until
and unless
(a) all the conditions which may be set out in grant of consent to establish are
complied with
(b) Consent to operate, both under Air (Prevention & Control of Pollution) Act-
1981 and Water (Prevention & Control of Pollution) Act- 1974 are obtained.
8- That all adequate measure to control water/ air pollution from the various
processes/ activity treatment will be taken to meet the prescribed standards as per
the Environment (Protection) Rules, 1986 as amended to date.
9- That for the Diesel Generate Set (s) (of capacity__________KVA) acoustic
enclosure/acoustic treatment will be provide to meet the prescribed norms w.r.t
noise as per the Gazette Notification of Ministry of Environment & Forests,
Government of India. Dated 02/01/99. Adequate stack height with D.G. Set(s) shall
also be provided and maintained.
10- That the cost of proposed pollution control measures has already been included in
the project report which amounts to Rs. ....................And shall only be used for
pollution control measures.
11- That the proposed industry is small/medium/large scale unit with SSI registration
No.....................................dated.........................................................
12- That all orders, direction and standards laid down by the Board, from time to
time, shall be complied with.
13- That the name and address of the Managing Director and other Directors are
given hereunder. Any change there of shall be intimated forthwith to the State
Board.

DEPONENT
VERIFICATION
Verified at----------------------on this----------------------(day, month and Year), that the above
contents of this affidavit are true and correct to the best of my Knowledge and belief and
noting has been concealed there from.
DEPONENT
 AFFIDAVIT
I------------------------S/o, D/o, W/o-------------------and
resident ---------------------------------------------of affirm
as under -
1. That I am Indian national .
2. That I am residing at---------------------------------- (address) &
enclosing a copy of Ration card / Electricity bill /Rent receipt/LIC
policy/Flat allotment letter/House registration paper as a resident
proof.
3. That I am also enclosing a copy of pan card /Driving license /passport
/voter ID other photo identity issued by state/central Government as a
proof of identity & date of birth.
4- That whenever I change my residence from present address to another I
will inform my Indene distributor in writing for change of address in
his record and complete necessary formalities as prescribed by IOC in
this regard.
5- That I confirm that I am not in possession of an LPG connection for my
domestic or a piped Natural Gas connection or piped LPG connection for
my domestic use either in my name or in name of any of my family
members(husband, wife, unmarried, children and deponent parents) who are
residing with me in my house.
6. That I confirm that the LPG connection issued to me will used my above
mentioned address only for authorized purpose as advised by IOC or
competent authority from time to time I am also aware that domestic LPG
supplied by Indian Oil corporation and/ or its authorized Indene
Distributors can presently by used only for domestic cooking purpose.
7. That I shall not position any other LPG gas installations in the same
kitchen.
8. That when second cylinder is issued to me I will use the same in the
same kitchen on the original installation only.
9. That if any information /declaration given by me in this affidavit or
any document submitted in support of identify /date of birth/ residence
proof shall be found to be untrue or incorrect or false Indene Oil
corporation and/ or its authorised Indene Distributors would be within
their rights to withdraw the supply of Gas/Terminate /seize the LPG
equipments & that I would have no claim what so ever against the Indene
Oil corporation and/ or its authorize Indene Distributors for such
withdrawal/Termination /Seizure.
I hereby verify and confirm that what has been stated above is true to the
best of my knowledge correct and nothing material has been concealed
there from .

Solemnly affirmed and declared before me this-------------day

of-----------------

Signature & seal of

notary public signature of person
make affidavit
Form A letter of Reference
CANIDATES NAME -

REFERENCE'S NAME-

OCCUPATION -

ADDRESS -

I understand that for --------------------------------------------Son of

------------------------------------------is seeking Employment/ Training in your
organization. He is personally known to me his educational qualification and
other family and residential details are correct. I do take full responsibility
for this conduct during his association with your organization.

Date Signature and seal of Reference

AFFIDAVIT
I------------------------------------------------W/O------------------------------------do hereby
solemnly confirm and declare that I am a Bharat Gas Consumer with Consumer
No.--------------------------------------and subscription Vouchar No.-------------------------and
Date--------------------------------------Vouchar has/have been lost by me.
CYL
DPR
I also confirm that in the event of the said subscription voucher is /are found at a
later date the same will not miscued but returned to the authorities concerned.

Deponent
DECLARATIOON
I-----------------------------------above deponent verify that the contents of my above
Affidavit and true and correct to the best of my knowledge and beli has cancelled there
in .

Place-------------------------
Date-------------------------- Deponent
2- Signature
 AFFIDAVIT
I------------------------------------------------W/O--------------------------------Permanent R/O
Village------------------------------------P.O----------------------Distt--------------------
State------------------------------------ I solemnly declared that the information submitted to
KVIC/KVIB/DIC is correct in all respect up to the hest of my knowledge and belif
Further declare that :-
1- I am prominent person of the society and at present there is on liability pending
against me for any Govt. Department/co-operative society and individual firms a
well as there in no any trial pending or inder consideration with crime or fraud.
2- I am not in Govt. Service.
3- I am applying for loan under PMEGP scheme.
4- I will set up the unit in the rural area certified by the revenue department in the
village----------------------------Po------------------------------------Tehsil
----------------------------------------------Distt-----------------------------------State
------------------------------------------------------------.
5- I will setup a new unit after getting loan from bank under PMEGP and will not
manipulate in any respect with old units .
6- I will abide completely by the rules and regulations laid down under PMEGP
scheme.
7- I will allow and co-operative the Govt. officials to inspect my unit installed under
PMEGP have full authority to recover the margin money with interest .
8- I will use the loan amount under PMEGP for setting up the unit for which it is
taken and will not mis-utilize it.
9- I will submit the progress report of the unit setup under PMEGP scheme to
KVIC/RKVIB/DIC as the case may be regularly in time without fail.
10- Myself or any of my responsible for any type of misutilisation of the loan under
PMEGP scheme.
11- Myself or any my family members have not availed any finical assistance under
REGP PMRY or any other scheme of Govt. of India or state Government scheme.
12- I have not availed/applied for any subside from any other Department for the
proposed unit.
Witness-
1- DEPONENT

2- Signature
OFFICE OF THE TEHSILDAR DANTARAMGARH (SIKAR)
S.L. No.------------- Date------------

CAST CERTIFICATE
1. Patwari cir
 AFFIDAVIT
Name Jitendra Kumar Jatolia
Father's Name Shiv Bhagwan Jatolia
Date Of Birth 18-07-1986
Age 22 Year
Residence of v/p KARNIPURA Via KHACHARIAWAS Teh. DANTA
RAMGARH Distt. SIKAR (Rajsthan). PIN 332710
Do solemnly affirm on oath that
1- My Date Of Birth is - 18-07-1986.
2- I Have passed my Secondary School examination as a Student of BAL VIDYA
MANDIR SEC SCH, DANTA From Board of secondary education , Raj. in Year
2001 with Roll No- 1864001
3- I Have passed senior secondary school examination as a student of GOVT SR
SEC SCH, KHACHARIAWAS from Board of Secondary education Rajsthan
in year 2003 with Roll No. 3053485 .
4- I Have passed D.Pharma as a student of SHREE BANJRANG COLLEGE OF
PHARMACY DEEG (BHARTPUR) RAJSTHAN from university of Rajsthan.
5- I Have under gone my practical training six Hundred Hours at MANDIA
MEDICAL & PROVISIONAL STORE opp. CHC KHACHARIAWAS SIKAR
(RAJSTHAN) from Date training 01-01-2007 to 15-04-07 where under went
training.
----------2-------
 (2)
6- I am neither employed nor carrying in any business of profession any
where as on date and residing at the following address.
Jitendra Kumar Jatolia S/o Shiv Bhagwan Jatolia Village Post-
KARNIPURA Via KHACHARIAWAS Teh. DANTA RAMGARH
Distt. SIKAR (Rajsthan). PIN 332710.
7- I Have not been registered as a pharmacist with any state pharmacy
council till date 18/04/2008.
8- I Have not applied for registration with rajsthan pharmacy council earlier.
9- If any of the information / Document submitted by me are ever found to be
incorrect and if ever it is found that I have suppressed any material fact of
made any miss presentation registration be cancelled fort with.
10- I under take to inform the registrar Raj. pharmacy council my professional
address immediately after taking of employment (as a registered
pharmacist /competent person on any drug licence or any other
employment ) and also promise to inform every change in my
professional address employment.
Place:-
Date:-
DEPONENT
VERIFICATION
Name Jitendra Kumar Jatolia
Father's Name Shiv Bhagwan Jatolia
Date Of Birth 18-07-1986
Age 22 Year
Residence of v/p KARNIPURA Via KHACHARIAWAS Teh. DANTA
RAMGARH Distt. SIKAR (Rajsthan). PIN 332710
do here by solemnly affirm on oath the content of above pars 1 t0 10 all true to
my knowledge and nothing has been cancelled.
Place :-
Date:-

DEPONENT
 AFFIDAVIT FOR CONSENT TO ESTABLISH(Crusher Only)

I-----------------------------------Director/Occupier/Partner-------------------of
M/S------------------------------------Location-----------------Aged----------------Resident of
-------------------------do hereby under taking on oathas follows:--
1- That this consent to Establish is being obtained for manufacturing of
addition/modifaction/alterration or change in process or raw material, We will
obtain fresh Consent to Establish.
2- That no trade effluent shall be generated from any of the processes.
3- That the production including the trial production shall not be undertaken until
and unless
(a) all the conditions which may be set out in grant of consent to establish are
complied with
(b) Consent to operate, both under Air (Prevention & Control of Pollution)
Act-1981 and Water (Prevention & Control of Pollution) Act-1974 are
obtained.
4- That the cost of proposed pollution control measures has already been included in
the project report which amounts to Rs ................. And shall only be used for
pollution control measures.
5- That the proposed industry is a small/medium/large scale unit with SSI
registration No. ................................. dated .......................... The cost of the project is
Rs ................................ lacs.
6- That all orders, directions and standards laid down by the Board, from time to
time, shall be complied with.
7- That unit shll have to adopt following additional measures.
 Dust containment com suppression system for equipments.
 Construction of wind breaking walls.
 Construction of metal led road with in the premises.
  Regular cleaning and wetting of the ground with in premises.
 Growing of green belt along periphery.
 That the stone crusher is observes the distance criteria from populations as
maintained below :-
Population of Residential Area Minimum Distance
200 300 Meter
201 to 500 500 Meter
501 to 1000 1 Kilometer
More than 1000 2 Kilometer
8- That the name and address of the Managing Director and of other Directors are
given hereunder. Any change there of shall be intimated forthwith to the State
Board.

DEPONENT
VERIFICATION
Verified at _________________________ on this __________________ (day, month and
year), that the above contents of this affidavit are true and correct to the best of my
knowledge and belief and nothing has been concealed there from.

DEPONENT
 AFFIDAVIT
I, Mr. Govind Singh S/o Mohan Singh Caste: Rajput Sub Caste: Rajput
Religion: Hindu of Village: Kanwar Pura Post : Bhagat Pura Tehsil: Danta
Ramgarh District: Sikar (Rajsthan) hereby solemnly declare as under :-

(a) That my Father's Name is: Mohan Singh

(b) That my Mother's Name is: Ful Kanwar
(c) That I have not been a member of any banned
political organization and have never been in
custody/jail and commercial or Judicial case is pending
against me in any Court of law in India/abroad .
(d) That I have not been convicted for any offence
under the law.

Signature
Verification :-
I the above deponent further solemnly affirm and declare that whatsoever is
stated in this affidavit is true and correct to the best of my knowledge and believe
and nothing has been concealed therein. If the same is found is incorrect I shall be
liable for disciplinary action as per law.
With Round Seal
Place:-
Date:-
The affidavit may be shown in the presence of Magistrate