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I , ARSHAD ULLAH KHAN Son of Shri SHARIF ULLAH KHAN presently

residing at NEAR URDU SCHOOL , TAKIA GOPALGANJ SAGAR (M.P) solemnly


affirm and say as follows
That my annual income (including income of the spouse) from all sources ( including
salary , business , rent , commission , Pension , income from land etc.) in the preceding year
ending the 31
st
arch , !"1# is $s 2,40,000/- (Two L!"# Fo$%&' &"o$#()# O(*') and I do
not belong to the creamy layer as stipulated in the %o&ernment of India '(PT )ircular *o.
3+"33,-,!""#./stt ($es) dated 1#.1".!""# as amended from time to time.
That the statements made in the foregoing paragraphs are true to my 0nowledge. I ma0e
myself personally responsible for the accuracy of the facts and figures furnished.
I further underta0e that in the e&ent of the particular gi&en in this declaration being
found false, I shall refund to the President of India '(123/ the amount of the scholarship to
the said scholar (s) and the %o&ernment4s decision on whether the declaration of particulars is
false shall be final and binding one me.
S+,(&$%- o. P%-(&
N/- +( F$**