Annexure II Specimen AFFIDAVIT (Application in case of "Awardee" only) I, No _________________Rank _______Name___________________ resident of village_________ PO ___________Tehsil ____________Distt _____________ and Awardee of _______________ solemnly affirm and declare as under : 1. That I have not taken/will not take any benefit for this award from any other state in future. 2. I am willing to accept monetary benefit for this award in lieu of land (in cases before 6.11.02) (in cases of MID award before 27.5.04) OR I am willing to accept lump sum amount in lieu of land and I shall not claim any other benefit for this award in future (in cases from 6.11.02 onwards except MID award) (in cases of MID award from 27.5.04 onwards) 3. That I understand and am conscious of the fact that this is one time lump sum award. As such I will not claim any other benefit such as land, cash award and annuity etc, under any pretext/rationale (in cases from 6.11.02 onwards except MID award) (in cases of MID award from 27.5.04 onwards). Place : Date Deponent Verification Verified at _____on this _______ day of ________ that the contents of the above affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein. Place : Date Deponent (Attested by Magistrate)
