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Print the below income declaration on the
Non-Judicial Stamp Paper (Rs. 10/-)
INCOME DECLARATION FORM
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 (2011-12):____________ Address: H.No.:____________
Course:
________ Course Year:_ Village
& Mandal:___________
College:
____________________________________ ___________ City & District: _____________
College
District:______________ Mobile No:_________
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