Self Declaration of Income Certificate

This self-declaration form is completed by an individual stating their personal details, caste, religion, and annual family income from various sources. The applicant affirms the truthfulness of the information provided and acknowledges the legal consequences of any misrepresentation. The declaration emphasizes the potential cancellation of benefits if the information is found to be false.

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Self Declaration of Income Certificate

Uploaded by

kabirajkeshab48

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

SELF DECLARATION

I Miss/Sri/Smt ......................................................................................
S/O, W/O, D/O ……………………………………………………… of Village ……………………………
G.P …………………………………… P.S ……………………….…. Tahasil ……………………………….
in the District of ……………………………………. do hereby declarethat, I am a resident of
Village ……………………………………………... since my birth/marriage i.e, .…....…….…years.
I have belongs to Caste ……………..…. And religion ………………………. Which is
recognized as ……………….. (SC/ST/OBC/SEBC). The annual income of my family
members is Rs. …………………../- only per annum from the sources specified below.

1. Agriculture Rs. …..……………..../-

2. Salary/Daily Wages/Renumeration etc. Rs. ……..…………..../-
3. Trade/Business/Profession Rs. ………..………..../-
4. Other Sources Rs. …………..……..../-

I do hereby declare that the above information given by me in this self

declaration/application form is true to the best of my knowledge and I have not
suppressed/ misrepresented any fact, that I am solely responsible for the accuracy of
the declaration and information furnished and shall be liable for action under section
199, 200 and 420 of Indian Penal Code(IPC) and other relaevent laws/rules in case
furnishing wrong declaration and information. Also I am well aware of the fact that the
certificate shall be summarily cancelled and all the benefits availed by me shall be
summarily withdrawn in case of furshing wrong declaration and information.

Signature of Applicant

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Self Declaration of Income Certificate

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Self Declaration of Income Certificate

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SELF DECLARATION

1. Agriculture Rs. …..……………..../-

I do hereby declare that the above information given by me in this self

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