GOVERNMENT OF TELANGANA
REVENUE DEPARTMENT
APPLICATION
INCOME CERTIFICATE
To
The Tahsildar Photo
_________________ Mandal,
_________________ Dist Telangana. Date : ___ / ___/ 20__
Applicant Name : __________________________
Relation : S/o,D/o,W/o,H/o,F/o,C/o,(with Name) : __________________________
Gender : Male / Female Date of Birth * : __________________________
ADDRESS:
Door No : ________________ Locality/ Land Mark : _______________________
District : ______________________ Mandal : _______________________
Village : _______________________ Pin code : ________________________
Ration Card No : _____________________________
Mobile No : ______________________________
AADHAAR NO : ______________________________
INCOME FROM ALL SOURCES (JOB, BUSINESS OR OTHERS) :
Income from Land and Buildings Rs. ________________________
__________________ By Business Rs. ________________________
Total Income of husband and Wife Rs. ________________________
____________________ Daily wage Earner Rs. ________________________
Income from Others Source’s Rs. ________________________
(Total Income Details)
Total : Rs. ________________________
Purpose of Certificate : ___________________________
The information submitted is true and accurate to the best of my knowledge. If
the information found incorrect, legal action as deemed fit.
Parents Signature. Signature of the Applicant
DOCUMENTS :
Application Form*
Proof of Address*: Aadhaar Car/ EPIC Card/ Gas Bill/ Electricity Bill/ Bank Passbook/ Ration Card/ Driving
License/ Post Office Account Statement/ Government-Issued Photo ID or PSU-Issued Service Photo ID Card.
Proof of Identity: Aadhaar Card/ EPIC Card or Any Other Identity Proof.
Proof of Income*: FSC Card/ Copy of IT Returns/ Pay Slip or Any Other Document Showing Income.