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Model Proforma of Declaration of Income in The Form of Affidavit

This document is an affidavit for parents or guardians to declare their annual family income when applying for a merit-cum-means scholarship from the West Bengal government. It states that the total annual family income for the previous year ending March 31, 2014 was a specific amount. It also declares that if any facts or figures provided are found to be false, the parent will refund the full scholarship amount paid to the student. The affidavit is signed and dated before a notary public or magistrate.

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sourav ghorai
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624 views1 page

Model Proforma of Declaration of Income in The Form of Affidavit

This document is an affidavit for parents or guardians to declare their annual family income when applying for a merit-cum-means scholarship from the West Bengal government. It states that the total annual family income for the previous year ending March 31, 2014 was a specific amount. It also declares that if any facts or figures provided are found to be false, the parent will refund the full scholarship amount paid to the student. The affidavit is signed and dated before a notary public or magistrate.

Uploaded by

sourav ghorai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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MODEL FORM OF DECLARATION OF INCOME IN THE FORM OF AFFIDAVIT

(To be given by the Parents/Guardians in case of both salaried/non-salaried income)

Whereas my son/daughter/dependent Shri/Kumari/Smt. ______________________________


a student of __________________________________ college/school has applied for grant of West
Bengal Govt. Merit-cum-Means Scholarship, I, Shri ____________________________ son of Shri
_______________________________________ (Address) ________________________________
do hereby declare that my total annual family income from all sources in the preceding year ending
31st March, 2014 is Rs.__________ (in words also)________________________________________).

I make myself personally responsible for the accuracy of the facts and figures furnished.

I further declare that in the event of the particulars given in this declaration being found to be
false I shall refund the whole amount of the scholarship paid to the said
_______________________________________ (Name of Student) and the Government decision
whether the declaration of particulars is false shall be final and binding on me.

Place : _________________

Date : ___________________ ___________________________


(Signature in full)

Affirmed /Sworn before me Identified by

____________________________

Signature of Notary Public/Ist Class Magistrate

Seal

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