MODEL PROFORMA FOR INCOME CERTIFICATE

(In
case of non-salaried Parent Guardian)
(To be glven by any Govt Officer not below the rank of Jt. B.D.O. in case of rural areas
Executive Officer in case of Municipality/Deputy Commissioner of
Corporation/GroupA
Gazetted Officer)

1 Certifty to he best of my knowledge that Shri/ Kumari /Smt. 0UPTTADEEP HAZRA

son/daughter/wife of Sri MHDHAB HAZRA resident of Village / Town: KOLKATA
P.S. MANICKTALA District KOLKATA is known to me for
TEN Years/Months).

His/Her Tather/Guardian/husband.Sa, permanent resident ofVillage town

KOLKATH P.S. MANICKTALA District KoLKATA State
LWEST_BENGGAE

The total annual family income from all sources of both the
parents/Guardian/Husband/Student for the year 2021-2022 is Rs. 26, 000/

vis
Place: KLUATA ASignature)
Somnath De, WBcS (Exe.)
Name i.Blocketters)
Date: 21- 10-22 Govt. of West Bengal

(Designation)
Full
Asbaai Munlcipal
The Kolkaa
3, S.N. BhetelsaMunkipal
Commissiener-
Road, Corpordon-
Kokate-7000t
N. B. In case of salaried person/ guardian salary certificate of the appropriate authority has to be
submitted.