SELF DECLARATION

r S r a v a n Deepak Redkar, s/o. Mr. Deepak Redkar, age 31 years, Indian

National, r/o. H.No. 221/A, Near Vishant Theatre, Aquem-Alto, Margao, Goa, do

hereby Solemnly State and affirm as under:

I say that my occupation is service & my family total annual income from all
other sources does not exceed Rs. 3.50,000/- (Rupees Three Lakh Fifty Thousand

only).
That our family comprises 02 members in my family including myself the details
of my family members are as tollW:-

The details of my family members are as follow:-

Sr Name Age Relation Occupation Monthly

No. Income

Sravan Deepak 31 Self Service 29,167-

Redkar
Priyanka Prakash 30 wife Housewife
Naik

I say that my total annual family income inciuding the undersigned from all other

sources is Rs. 3,50,000/-

I say that I have sworn this self declaration to obtain an Income Certificate from
before the
the Margao Municipal Council, Margao-Goa, Same to be Produce
Directorate of Social Welfare, Panaji-Goa, for the purpose of availing Ex-Gratia

Financial assistance to the family of the victims of Covid-19.

at
lfanything is found be contrary is Margao Municipal Council, Margao-Goa,
to

liberty to revoke/cancel /withdrawn and the same with any reason or notice.

that whatever stated above paras are true and correct to the best ot my
say
knowledge.
Solemnly atiirmed at Margao-Goa.

Date:

Place

DECLARANT