DECLARATION OF PARENTS/GUARDIAN INCOME

I, G. PACKIYAMANI (Parent/Guardian) of G. ANILKUMAR (Name of the student) who is

studying in X Std, St. Marys Boys Hr Sec School at Thoothukudi do hereby declare that my
annual income from all sources is Rs. 66,000/- (Rupees Sixty Six thousand only).

I, G. PACKIYAMANI declare that the above information given by me is true to the best of my
knowledge to avail the benefits given to my son/daughter/ward and it is found that if the
information given by me is false, the scholarship amount sanctioned could be withdrawn or
recovered from me and legal action as deemed fit, may taken against me or my ward.

Date: 12/12/2017

Signature.
Residential Address:
5/201 E, South Colony,
Kasilingapuram,
Singathakurichi Post,
Thoothukudi 628851.