Sunteți pe pagina 1din 2

Print the below income declaration on the

Non-Judicial Stamp Paper (Rs. 10/-


INCOME DECLARATION FORM
Name of the Student
1. (i) Name of the 4. Business mention the
Father trade/name of business
(ii) Whether Income derived from the
Employed venture
(iii) if employed, 5. (i) No. of Vehicles owned by the
Designation Family
(iv) Salary per month (ii) Whether used for
personal/private use only
2. (i) Name of the (iii) Mention type of vehicles Regd. No.
Mother (two wheeler/ three
wheeler/four wheeler)
(ii) Whether (iv) Vehicle registered on
Employed whose name
(iii) if employed, 6. (i) Type of House: Mention
Designation whether RCC, thatched/Tiled
roofed
(iv) Salary per month (ii) Mention whether
Indiramma House
3. Agricultural holding (iii) Cost of Construction of
of the parents House
mention extent
(i) In the name of the (iv) Whether Constructed with
Father loan, if so amount and Bank
Branch
(ii) In the name of the (v) Any other type of house
Mother
a) Crops Grown in land 7. (i) Whether living in own
house or rented house
b) Whether Dry or Wet (ii) if rented, mention rent
land amount
c) Annual Income from 8 Telephone / Mobile Number
Agricultural Land
9. Total Family income from all
sources.

I hereby declare that the above information given is true & correct. I will be held liable for any wrong
information given which shall include cancellation of scholarship, recovery of amounts paid already if any
besides criminal action.

Name & Signature of the Student Name & Signature of the Parent
EPASS Application ID (2015-16):____________ Address: H.No.:____________
Course: ________ Course Year:_ Village & Mandal:___________
College: _______________________________ City & District: _____________
College District:______________ Mobile No:_________
Mobile No:__________

S-ar putea să vă placă și