Monday, August 6, 2012

EPASS RENEWAL APPLICATION 2012-13




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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 Father


4.
Business mention the trade/name of business


(ii) Whether Employed



Income derived from the venture


(iii) if employed, Designation


5.
(i) No. of Vehicles owned by the Family


(iv) Salary per month



(ii) Whether used for personal/private use only


2.
(i) Name of the Mother



(iii) Mention type of vehicles (two wheeler/ three wheeler/four wheeler)

Regd. No.
(ii) Whether Employed



(iv) Vehicle registered on whose name


(iii) if employed, Designation


6.
(i) Type of House: Mention whether RCC, thatched/Tiled roofed



(iv) Salary per month



(ii) Mention whether Indiramma House


3.
Agricultural holding of the parents mention extent



(iii) Cost of Construction of House


(i) In the name of the Father



(iv) Whether Constructed with loan, if so amount and Bank Branch


(ii) In the name of the Mother



(v)  Any other type of house


(a)
Crops Grown in land


7.
(i) Whether living in own house or rented house


(b)
Whether Dry or Wet land



(ii) if rented, mention rent amount


(c)
Annual Income from Agricultural Land


8
Telephone / Mobile Number






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 (2011-12):____________                                                  Address: H.No.:____________
Course: ­­­________    Course Year:_                                                                        Village & Mandal:___________            
College: ____________________________________          ___________          City & District: _____________
College District:______________                                                                          Mobile No:_________
Mobile No:__________ 

                     For more details visit official website at "http://epass.cgg.gov.in/"                                                                                                        

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