I, Mr. ..............., residing at .................., Bombay(Mumbai), do hereby state on solemn affirmation as follows :

1. I say that I am the father of female/male minor born on ............
2. I say that the date of birth of the said minor is................, There is no other document or record stating the said date of birth of the said minor and no such other document can be traced by any amount of diligence.
3. It is therefore the intention of this document that it be used as Birthdate Certificate for all purposes allowed by the Law including the child's school admission purpose.

Solemnly affirmed at Bombay/Mumbai on this 13th day of December, 1990.
Before me


Notary