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    ApplicationForm, Self Declarationand Pre Verification Report Format

    Uploaded by

    Anuj Goel
    This document is an application for an EWS (Economically Weaker Section) certificate in India. It requests information such as the applicant's name, address, family details, income sources, and ration card number. The applicant must declare that their total annual family income from all members over 18 years of age is less than 300,000 INR. They must attach documents like their ration card, identity proof, income proof for earning family members, and a self-declaration.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    ApplicationForm, Self Declarationand Pre Verification Report Format

    Uploaded by

    Anuj Goel
    140 views4 pages
    This document is an application for an EWS (Economically Weaker Section) certificate in India. It requests information such as the applicant's name, address, family details, income sources, and ration card number. The applicant must declare that their total annual family income from all members over 18 years of age is less than 300,000 INR. They must attach documents like their ration card, identity proof, income proof for earning family members, and a self-declaration.

    Original Title

    ApplicationForm,Self Declarationand Pre Verification Report Format

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    This document is an application for an EWS (Economically Weaker Section) certificate in India. It requests information such as the applicant's name, address, family details, income sources, and ration card number. The applicant must declare that their total annual family income from all members over 18 years of age is less than 300,000 INR. They must attach documents like their ration card, identity proof, income proof for earning family members, and a self-declaration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    140 views4 pages

    ApplicationForm, Self Declarationand Pre Verification Report Format

    Uploaded by

    Anuj Goel
    This document is an application for an EWS (Economically Weaker Section) certificate in India. It requests information such as the applicant's name, address, family details, income sources, and ration card number. The applicant must declare that their total annual family income from all members over 18 years of age is less than 300,000 INR. They must attach documents like their ration card, identity proof, income proof for earning family members, and a self-declaration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    Recent Passport

    Size
    Attested
    photograph
    (Financial Year) of the Head of
    Family
    Application for EWS Certificate
    (Only for allotment of residential flat/residential plot by Housing Board)

    1) Full Name of Head of Family __________________


    (Head of Family as defined in Ration Card)
    2) Father Name / Husband Name
    3) Date of Birth of Head of Family __________________

    4) Gender __________________

    5) Marital Status __________________

    6) District __________________

    7) Address __________________

    8) Pin Code __________________

    9) Post Office __________________

    10) Email ID __________________

    11) Mobile Number __________________

    12) Family ID __________________

    13) Ration Card Number __________________

    14) Number of Adult Family Members __________________


    (above the age of 18 years)

    15) Number of earning Adult Family Members __________________


    (above the age of 18 years)

    16) Total Family Income Rs/ -__________________ (in words)


    (Family Income counted from all the sources)

    17) Please select sources of income for household members (Checkbox):


    Agriculture Professional Salary Business Other Sources

    I hereby declare that the information filled in this form are true and correct to the best of my knowledge
    and I undertake to inform you of any changes therein, immediately. In case any of the above information is
    found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it by the
    state.

    Date ______________ Signature of Applicant

    Place______________
    Attach following Documents

    1. Copy of Ration Card (*) Mandatory

    2. Identity Proof (Any one of the following):


    a. Passport
    b. Driving License
    c. Voter ID Card
    d. Aadhaar Card

    3. Resident Proof/Address Proof/Ownership Proof (Any one of the following):


    a. Passport
    b. Driving License
    c. Voter ID Card
    d. Aadhaar Card

    4. Income Proof for each of the earning members (Kindly attach the following as applicable):
    a. For those who are Income Tax Payers (Salary/Business/Professional): Income Tax
    Returns for the last 3 years
    b. For those who are not Income Tax Payers but are salaried class: Income Certificate
    issued by Employer for the last three years
    c. For Agricultural Income: Income certificate verified by Patwari and issued by Naib
    Tehsildar/Tehsildar/Executive Magistrate
    d. For other source income Income certificate verified by Patwari and issued by Naib
    Tehsildar/Tehsildar/Executive Magistrate

    5. Self-Declaration By Applicant
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