Revised February 2018

SELF EMPLOYMENT DECLARATION OF INCOME (INFORMAL

BUSINESS)

I ……………………………………………………………………………………...
Declare as follows:

1. That I reside at …………………………………………………………………………

……………………………………………in the parish of ……………………………

2. My contact number is …………………………………………………………………

3. I have been self-employed as a ……………………………………………………….

Since……………………………………………………………..

4. I am estimated to earn ________________________________________________

(Weekly, Fortnightly, Monthly, Annually)

5. Declared by the said ______________________________ ____________________

First and Last Name Signature

In the presence of ______________________________ _______________________________

Name of Justice of the Peace Signature of Justice of the Peace

Dated: _____________________________
dd/mm/yyyy

Applicant Name: _____________________________ Applicant TRN: ___________________________