Name of the Student

1.

2.

3.

(a)
(b)
(c)

INCOME DECLARATION FORM

SUNKARA SUBRAMANYAM

(i) Name of the Father

S.RAJA

4.

(ii) Whether Employed

(iii)
if
employed,
Designation
(iv) Salary per month

NO
COOLI

5.

(i) Name of the Mother

(ii) Whether Employed
(iii)
if
employed,
Designation
(iv) Salary per month
Agricultural holding of the
parents mention extent
(i) In the name of the
Father
(ii) In the name of the
Mother
Crops Grown in land
Whether Dry or Wet land
Annual
Income
from
Agricultural Land

NO
S.VENKATA
RATHNAMMA
HOUSE WIFE
NO

6.

NO
NO
NO
NO
NO

7.

NO
NO

Business mention the trade/name of

business
Income derived from the venture
(i) No. of Vehicles owned by the Family

NO

(ii) Whether used for personal/private

use only
(iii) Mention type of vehicles (two
wheeler/ three wheeler/four wheeler)
(iv) Vehicle registered on whose name
(i) Type of House: Mention whether
RCC, thatched/Tiled roofed
(ii) Mention whether Indiramma House
(iii) Cost of Construction of House

NO

NO
NO

NO
NO
RCC HOUSE
NO
NO

(iv) Whether Constructed with loan, if

so amount and Bank Branch
(v) Any other type of house

NO

(i) Whether living in own house or

rented house
(ii) if rented, mention rent amount
Telephone / Mobile Number

OWN HOUSE

NO

NO
8520009276

9.
Total Family income from all sources.
RS :48,000/I hereby declare that the above information given is true & correct. I will be held liable for any wrong information given
which shall include cancellation of scholarship, recovery of amounts paid already if any besides criminal action.
Name & Signature of the Student
ePASS Application ID (2013-14): 201304797338
Course: DEGREE (BSC) Course Year: III Year
College: CGR DEGREE COLLEGE RAJAMPET
College District: Kadapa
Mobile No:

Name &Signature of the Parent :

Address:H.No.: 5/180 Kolimi Street
Village & Mandal:Rajampet
City & District: Kadapa
Mobile No:_ 8520009276