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Family Income Self Declaration for Scholarship

This document is a self-declaration form for a Pre-Matric scholarship scheme run by the Ministry of Minority Affairs, Government of India. The parent or legal guardian declares that (1) they are an Indian citizen, (2) their son/daughter is a student in class X at a particular school, (3) the family's annual income from all sources is a certain amount, and (4) they or their spouse is an earning member of the family. The parent certifies that the information provided is true and understands that providing false information could result in legal action.

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1K views2 pages

Family Income Self Declaration for Scholarship

This document is a self-declaration form for a Pre-Matric scholarship scheme run by the Ministry of Minority Affairs, Government of India. The parent or legal guardian declares that (1) they are an Indian citizen, (2) their son/daughter is a student in class X at a particular school, (3) the family's annual income from all sources is a certain amount, and (4) they or their spouse is an earning member of the family. The parent certifies that the information provided is true and understands that providing false information could result in legal action.

Uploaded by

Vairamuthu
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Declaration of Income
  • Acknowledgement and Signature

SELF DECLARATION OF FAMILY INCOME UNDER PRE MATRIC

SCHOLARSHIP SCHEME (FOR CLASS I TO X) OF MINISTRY OF MINORITY


OF AFFAIRS,
GOVERNMENT OF INDIA
(To be given by the Parent / Legal Guardian)

I, ______________________________________ Son / Daughter / of


_____________________________
Resident of (full address)
________________________________________________________________
_______________________________________________________________________________________
do hereby solemnly affirm and declare as under : a) That I am citizen of India.
b) That my son / daughter / ward namely Master / Kumari
________________________________ is a student of class ______________ in
______________________________________________ (name & address of school)
_______________________________________________________ at
_____________________________________________________________ (District & State).
c) His / Her enrollment no. in school is _________________________________ for the
academic Session _______________________.
d) That annual income of my family all sources is Rs. ___________________________ (in
words also)
____________________________________________________________________________
e) I declare that I / my wife / both* am / are earning Member(s) in my family.
2. I certify that the above information given by me is true.
3. In case this information furnished by me is found false, the financial assistance
awarded to my ward may be recovered with penal interest and I will be liable to a
legal action against me in accordance with law.

Signature of Parent / Legal Guardian

____________________________________
Name of Parent / Legal Guardian

____________________________________
* Strike off the non applicable part in the underlined clause above.

SELF DECLARATION OF FAMILY INCOME UNDER PRE MATRIC SCHOLARSHIP SCHEME (FOR CLASS I TO X) OF MINISTRY OF MINORITY OF AFFAIRS,
Signature of Parent / Legal Guardian : ____________________________________ Name of Parent / Legal Guardian : ___________

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