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Declaration of Income and Minority STATUS

I KHAN MOHD. HAKIK (Guardian) of KHAN JUBER AHMED RABIULLAH. Who is studying in 6th H1 hereby declare that my annual income from all source is Rs: 96000 in words Rs: Ninety Six Thousand only. I also declare that I belong to Muslim minority Community declared as minority community by government of Maharashtra, general administrative department notification no RAA/2005/89/C.R.19/2005, dated 9th November 2006. If at any stage, it is found the information given by me is false /not true, all benefits given to the student under any scheme could be withdrawn and legal action as deemed fit, may be taken against me or my ward.

Date:

Student Signature

Guardian Signature

Resident Address: (A-1)-9, Room no. 404, Bharat CHS, MMRDA Colony, Antop hill, Wadala, Mumbai400037.

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