Print the below income declaration on the
Non-Judicial Stamp Paper (Rs. 10/-)
INCOME DECLARATION
FORM
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Name of the Student
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1.
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(i) Name of
the Father
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4.
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Business
mention the trade/name of business
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(ii)
Whether Employed
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Income
derived from the venture
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(iii) if
employed, Designation
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5.
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(i) No. of
Vehicles owned by the Family
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(iv) Salary
per month
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(ii)
Whether used for personal/private use only
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2.
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(i) Name of
the Mother
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(iii)
Mention type of vehicles (two wheeler/ three wheeler/four wheeler)
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Regd. No.
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(ii)
Whether Employed
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(iv)
Vehicle registered on whose name
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(iii) if
employed, Designation
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6.
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(i) Type of
House: Mention whether RCC, thatched/Tiled roofed
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(iv) Salary
per month
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(ii)
Mention whether Indiramma House
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3.
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Agricultural
holding of the parents mention extent
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(iii) Cost
of Construction of House
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(i) In the
name of the Father
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(iv)
Whether Constructed with loan, if so amount and Bank Branch
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(ii) In the
name of the Mother
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(v) Any other type of house
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(a)
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Crops Grown
in land
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7.
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(i) Whether
living in own house or rented house
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(b)
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Whether Dry
or Wet land
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(ii) if
rented, mention rent amount
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(c)
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Annual
Income from Agricultural Land
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8
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Telephone /
Mobile Number
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9.
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Total
Family income from all sources.
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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 (2012-13):____________ Address:
H.No.:____________
Course:
________ Course Year:_ Village
& Mandal:___________
College:
____________________________________ ___________ City
& District: _____________
College
District:______________ Mobile
No:_________
Mobile
No:__________
