Life Insurance Corporation of India

_______________Division

AGRICULTURAL INCOME CERTIFICATE

Date:
Branch :

Proposal No :

Name :

Name & Address of the person in whose name :

The property stands

Name of the village :

Name of the Taluk :

SF Nos. :

Extent of the land and :

Nature of Land (Dry/Wet) :

Market value of the lands owned by the :

Applicant :

Nature of crops grown :

Annual Income Year-wise (Gross and Net Income separately) during each of the last 3 financial years.
Year ending Year ending Year ending
1999-2000 2000-2001 2001-2002
Rs. Rs. Rs.

Gross

Net

Date of Office Seal Signature of Tahsildar

NOTE:

This certificate should be signed by Tahsildar and

Should bear the seal of the Issuing Officer and the
Date of Issue.