Annexure - 1
Undertaking on Annual Income
I, ……………………………...…, father/mother/guardian of …………..………………...., of
Vill./Tea Garden …………………………..……………… P.O. …………….…….………………………… Sub-Division
………………………………. Dist. ………………………….... do hereby affirm that my annual family income from
all sources is (tick the appropriate box) below above Rs. 5.00 (five) lakh only, and if
found otherwise, I shall be liable for action under the existing law.
Signature of
Date: ……………………………….. father/mother/guardian
Recommendation Letter from Head of the Institution
Date:……………………….
This is to certify that Shri / Smt. ............................................
S/o. / D/o. / W/o. ................................. of vill./TE. ......................................,
P.O. ......................................... Sub-Division ….............................................,
District .................................................. is a student of my school / college
and is presently studying in Class - ……… / Semester …………. I recommend
him / her as eligible to avail the “Post- Matric Scholarship Scheme” from
Tea Tribes Welfare Department for the financial year …………………
Seal & Signature of Head of
the Institution