Statement as to place of ordinary residence by a person holding a Declared Office

Full name ____________ Father's/Husband's Name ____________ Age ____________ Years ____________ Office held ____________ I hereby declare that I am a citizen of India and that but for my holding the above-mentioned office, I would have been ordinarily resident at (full postal address) ____________. I further declare that my wife/husband (name) ____________ aged ____________ years, ordinarily resides with me (and is a citizen of India). This cancels any previous statement as to place of ordinary residence made by me. Signature ____________ Place ____________ Date ____________