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Scheme of Award of Prizes to Hindi Writers

 
     
 
 
 
     

Shiksha Puraskar Yojna


Declaration Form

 

       I ________________________________________________ son/ daughter/ wife of __________________ _____________________ Resident of __________________________________________________________
_________________________________ hereby declare that:-

 

A)
I am a resident of (State/ Union Territory) __________________________________________________
B)
I was born at ______________________________________________ located in (state/ Union Territory) ________________________________ .
C)
My mother tongue is _________________________________________.
D)
Under the scheme referred to above the book ______________________________ submitted by me has never been awarded earlier by Central Government or any State Government or by any Undertakings/ institutions under them or by any professional institution.
E)
I have already been awarded in (Year) _____________ for my book _____________________________
____________________________ under Shiksha Puraskar Yojana.
F)
I am an employee of Department of _______________________________ Central/ State Government and I have received witten permission from the concerned officer of my Department to participate in the scheme (attested copy of permission enclosed).
   
I do hereby solemnly declare that the above information is true to the best of my knowledge and belief.
   

Place: ______________________
Date: ______________________

________________________________
Signature of Applicant
 
     
 
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