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The document is an application for remission of fees submitted by Kadiyala Sai Susrush, a B.Tech student at IIT Bombay, detailing personal and parental information, including a declaration of gross income of Rs. 96,000 for the financial year 2021-22. It includes a self-attested income certificate and emphasizes the student's responsibility for the accuracy of the information provided. The student acknowledges the consequences of submitting false information, including potential disciplinary actions and the impact on scholarship eligibility.

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Sai Susrush Kadiyala
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12 views3 pages

Page: 1 / 3updated: 2022-08-17 - 15:56:25

The document is an application for remission of fees submitted by Kadiyala Sai Susrush, a B.Tech student at IIT Bombay, detailing personal and parental information, including a declaration of gross income of Rs. 96,000 for the financial year 2021-22. It includes a self-attested income certificate and emphasizes the student's responsibility for the accuracy of the information provided. The student acknowledges the consequences of submitting false information, including potential disciplinary actions and the impact on scholarship eligibility.

Uploaded by

Sai Susrush Kadiyala
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Indian Institute of Technology Bombay

Student Personal Information


Application for Remission of Fees Updated on 2022-08-17_15:56:24
Kadiyala Sai Roll
Name 210070038 Department Electrical Engineering
Susrush Number
Programme B.Tech. Hostel H16 Email [email protected]

Permanent Address D.NO. 17-23, PLOT NO. 35-36-37, 1ST ROAD Present Address D.NO. 17-23, PLOT NO. 35-36-37, 1ST ROAD
: Padmanabhapuram colony, Andhra Padmanabhapuram colony, Andhra
Pradesh 521137 Pradesh 521137
Vijayawada (Rural) Vijayawada (Rural)
ANDHRA PRADESH ANDHRA PRADESH
PinCode : 521137 PinCode : 521137
Phone Number : 9440308806 Phone Number : 0000000000
Aadhar Number & nbsp;
502622312295
(UID) : Parent Email: [email protected]
Parent Name: KADIYALA SUBBA RAO Office Phone
9440308806
Parent Contact Number :
Number 9348308806
(Multiple allowed):
Nearest Railway
Vijayawada
Station

I hereby declare that gross income of my parents for the Financial year 2021-22 (i.e. Assessment year 2022-23) is Rs. 96000/- (in
words) Rupees ninety six thousand.
I am not required to file IT return in accordance with Income Tax Act 1961, therefore I have uploaded self-attested copy of Parental
Income Certificate for the financial year 2021-2022 issued on/after 1-April-2022 by a competent authority.
1. Income certificate is issued by the competent authority as per the list of INCOME CERTIFICATE ISSUING AUTHORITY IN VARIOUS
STATES/UNION TERRITORIES ? : Yes
2. Date of issue of income certificate 2022-04-20
3. Income certificate is issued after 1st April 2022? Yes
4. At-least one of the parents name in ASC records [KADIYALA SUBBA RAO] is matching with the name of whose income certificate is
uploaded? : Yes
5. State/UT for issuance of Income certificate. : ANDHRA PRADESH
6. Validity of income certificate is 31st March 2023? : Yes
6a. Validity of income certificate? : 2026-04-19
7. All uploaded certificates are self-attested? : Yes

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I further declare that the above information is true to the best of my knowledge and belief and I am aware that I am solely responsible
for the correctness and accuracy of the above declaration and understand that providing false information amounts to misconduct and
may lead to cancellation of admission at IIT Bombay. I further authorize IIT Bombay to verify my income. I hereby declare that the
information entered above is true to the best of knowledge. I authorize IIT Bombay to verify this information if so required.

My action of submitting this form implies that I accept the following.


1. I am fully responsible for submitting above information. If any of above is found untrue IIT Bombay may deny me facilities which I
wish to obtain by submitting above information. Further, I understand that by virtue of submitting incorrect information I may become
liable for disciplinary action as decided by competent authority at IIT Bombay.
2. I will not hold IIT Bombay responsible for any action arising out of incorrect information submitted by me.
My parental Annual Gross Income is true as shown above from all sources and if the same found false, I shall be liable to be
discontinued & debarred from scholarship for the entire period of my programme. In case I am awarded any scholarship/stipend etc. in
future, I shall intimate the same to the Institute and shall refund the entire amount of the Institute scholarship received by me before
receiving the other scholarship, stipend etc. for the year.

Date : _______________________
Date : _______________________
Name : _______________________
Name : Kadiyala Sai Susrush
_______________________ (Parent's
_______________________ (Student's signature)
signature)
Updated on : 17-08-2022

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