APPLICATION FORM FOR DOMICILE CERTIFICATE GOVERNMENT OF ARUNCHAL PRADESH OFFICE OF DEPUTY COMMISSIONER (To be filled up by the Applicant) 1. Full Name of the person for whom required the certificate is required 2. Father's/ Husband' s Name 3. Name of the Applicant 4. Permanent address Village Post Office Police Station District State 5. Present Address C/o Village Post Office Police Station District 6. Name of Guardian 7. Relation with Guardian 8. Occupation/ Designation of Guardian 9. Specific purpose for which the certificate is required 10. Affidavit in case non- Govt. employees applicant endorsed or not 11. Residing at present address since 12. Contact No. Yes No how long Signature of Applicant Published on National Portal of India (india.gov.in) years Verification certified by concerned H. O. D / Bazaar Secretary/ Admin. Officer Certified that the above particulars furnished by the applicant is correct to the best of my knowledge and belief as per service record/ ** For govt. employees - H.O.D For businessmen - Bazaar Secretary For others - Admin. Officer of concerned area Certified Permanent address given as serial no.4 is duly affidavited by the applicant Signature Administrative Officer of the Area (With seal) Enclosures: 1. Affidavit in standard format (in case of Non-Govt. employees) 2. Passport size photo - 02 nos. Signature Head of Office/ Bazaar Secretary/ Admin. Officer / Published on National Portal of India (india.gov.in)
