Sub:- Application for issue of Income Certificate-Requested Regarding.
Respected Sir,
I,_________________________________________________________________________ S/o,D/o,W/o.______________________________________________________________________ R/o. House No.____________________________________________________________________ I beg to state the following few line for your kind consideration and favorable orders. Herewith enclosing the Ration Card Copies and Affidavit two different State Govt. Gazetted Officers, i.e. INCOME CERTIFICATE of myself.
I am residing in the above address which is in the Jurisdiction of Khairatabad Mandal. On the strength of certified copies submitted to you for verification. I may kindly be issued Income Certificate, on receipt of certificates from Mandal Officer. I will submit the same in ___________________________________________________________ for the purpose of __________________________________________________________________ I, therefore humbly request you to issue me the Income Certificate.
Thanking you, Yours faithfully,
Date: / /20 ( ) Place: Hyderabad, A.P Certificates enclosed (Attested by the Gazetted Officer): ( )
1) Two different State Govt. Gazetted Officers Certificate. 2) Affidavit with Notary on Rs. 10/- Bond Paper. 3) T.C or Bonafides Xerox with Attested by the State Gazetted Officer. 4) Ration Card with Attested by the State Gazetted Officer. 5) Photo Identity Card Issued by the Election Commission or Electorate rolls from Municipality. 6) Salary certificate issued by the Employer.
DECLARATION I declare that the information furnished by me in this application is true and correct. If it is found to be untrue and incorrect. I will be liable for prosecution for furnishing false information under Section 199 and 200 of I.P.C.
SIGNAURE OF THE APPLICANT ( ) Affix 2 Rupees Court Fee Stamp
Income Certificate
This is to certify that Sri/Smt. /Kum.____________________________________________________ S/o,D/o,W/o._____________________________________________________________________________ R/o. H No._______________________________________________________________________________ is residing in the above Address and working Privately/ Private Servant/ Own Petty Business as a_______________________________________________________________________________________ His/Her monthly Income is Rs.___________________ and annual Income is Rs._______________________ With all sources.
I know him/her well with the best of my knowledge and hence this income certificate is issued under G.O. Ms. No. 554 dt:4-8-1988 Revenue (A) Dept., and G.O. Ms. No. 178 dated: 6-8-1988, Social Welfare (J2) Dept. G.o. Ms. No. 289 dated 28-11-1989, Social Welfare Department.
Signature of the State Gazetted Officer Date: Designation: Official Seal: NAME:
Income Certificate
This is to certify that Sri/Smt. /Kum.____________________________________________________ S/o,D/o,W/o._____________________________________________________________________________ R/o. H No._______________________________________________________________________________ is residing in the above Address and working Privately/ Private Servant/ Own Petty Business as a_______________________________________________________________________________________ His/Her monthly Income is Rs.___________________ and annual Income is Rs._______________________ With all sources.
I know him/her well with the best of my knowledge and hence this income certificate is issued under G.O. Ms. No. 554 dt:4-8-1988 Revenue (A) Dept., and G.O. Ms. No. 178 dated: 6-8-1988, Social Welfare (J2) Dept. G.o. Ms. No. 289 dated 28-11-1989, Social Welfare Department.
Signature of the State Gazetted Officer Date: Designation: Official Seal: NAME: