|
* Affix Your
Passport Size Photo Here |
Applicant Details:
| Applicant Name*: | Father Name*: |
| Gender*: | Date of Birth: |
| Aadhaar Number (optional): |
| Caste Category*: | Sub Caste Category*: |
Present Address:
| Door No*: | Locality/Landmark: |
| State*: |
| District*: | Mandal*: | Village*: | Pincode*: |
Postal Address is same as Permanent Address:
| Door No*: | Locality/Landmark: |
| State*: |
| District*: | Mandal*: | Village*: | Pincode*: |
| Mobile Number*: | Mail Id: |
| Ration Card Number: |
Income Details*:
Gross Annual Income includes Salary, Agriculture, Business, Profession etc., for
the financial year prior to the year of application (Applicant/His/Her Family*):
_________________ (In Rupees)
Assets Information (Applicant/ His/Her/Family*):
i) 5 Acres of agricultural Land and above : Yes/No
ii) Residential flat of 1000 sq. ft. and above: Yes/No
iii) Residential plot of 100 sq. yards and above in notified municipalities:
Yes/No
iv) Residential plot of 200 sq. yards and above in areas other than the notified
municipalities: Yes/No
benefit of Reservation , His/Her parents and siblings below the age of 18 years
as also His/Her spouse and children below the age of 18 years.
Documents to be uploaded:
i) Application Form*
ii) Ration Card/Epic Card/Aadhaar Card*
iii) Copy of IT Returns/Pay Slips (Any of other Documents)
iv) Affidavit
Note:
- ͏ I hereby declare that the above mentioned information is furnished on best of
my knowledge. If information & declaration is found false, I am liable for
prosecution. - I don’t belong to SC, ST and BC/OBC Caste.
* Represents all the fields are mandatory.
| Date: | Signature of the Applicant |
Pradesh Govt other state govt authorities may use their own format. This
form may be useful to understand the requirement of terms to get the EWS
Certificate.
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