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Download Self Declaration for Goa Residence Certificate
Goa Residence Certificate - Self Declaration Format / Download
The Goa State Government issues people with domicile certificates, which are official documents. To demonstrate your residency in the State, you must obtain a domicile certificate.
FOR RESIDENCE CERTIFICATE DECLARATION (along with Photo)
I, the undersigned , Indian National, Single/Married/Widow/Widower/Divorcee, major in age/ years, resident of in Taluka , District , State of Goa do hereby solemnly affirm and state/declare as under:
1. I say that I am permanent resident of above mentioned address.
2. I say that my name is recorded on ration card bearing No. and I also possess EPIC/ Voting card bearing No.
3. I say that since my birth i.e. from the year to till date I am continuously residing at above mentioned address with my family. OR I say that I was residing at from (year) to (year) and thereafter I had shifted from that place and residing at (year) till date with my family. since -
4. I say that I have taken myeducation in (Name of the State/Place) and in (Name of the State/Place), however I have not surrendered my residential status in Goa.
5. I say that, I am permanent resident of State of Goa since more than 15 years.
6. I say that I am executing this declaration in order to produce the same in the office of the Mamlatdar of Taluka, Goa,in order to apply for Residence Certificate which is required to produce before Competent Authority.
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11. I say that the contents of above paras of my declaration are true to the best of my knowledge and belief and that I have not misrepresented any facts.
Place:
Date:
Identified by:
DEPONENT
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