FORM HOME TOWN DECLARATION [ OM No

Date: issued 24-6-1958. FORM HOME TOWN DECLARATION [ OM No. 43/15/57-Estts. (A) dated 24-6-1958 ] I, ___________________________hereby declare that my home town is at the place as shown below for the purpose of availing my self of the Travel Concession as notified in the Govt. of India, Ministry of Home Affairs, New Delhi O.M. No. 43/1/55/Estts - (A) Part-II dated 11-1-1956 conveyed vide Secretary (Finance) to the Delhi (Extractive summary — verify with official source.)