wate af iota | LOTT TT APPLICATION FOR ISSUE INCOME CERTIFICATE Wels Hid|] WW UAS Tou af, ‘The Mamlatadar / wctcet2, Duséla, [Name ofthe address of the 4 Uevelee AHL WA Bet = spplicant From = J 2aelt = 2, Date of the birth / want cdtvi= Place of the Birth / eH wn 3, Profession / ataua = % lam married / Unmarried, weg 7 ouegle 1. Name of my wife/Husband/Father/Mother AURAL tet Ret HisiHer Profession Ame saa Age caraanel Number of earning member in the family onal suet calsevdl = Details regarding their monthly Income are as under! adel etasel acl oD yer, Sr] Yearly | _ Income for No. ‘Age | Profession | Income | the Year aul Name / #3 gue | ua | lls sil ell ioe | suas | tues + 1got children. The details are as under = é al aig y Adee Bate ofl pve B. Sr 1 No. ‘Age | Profession / suis Name Fat oe Occupation cee alates |Descripion of immovable property [|x Beret od Brae rel ss Vy wife? husband do [does not own immovable property gad vol WA al ete Res RGA al a Vey! family member do not have any income other sources VIZ. interest on Bank deposit ete. details are as under = € Gar ud sion Aeedll ty AT meas oa Rael} As ryt Bell Gel fl ye. ‘Source of Income / mased aut Fof income / zai WA Bie Vy Tamily do not have any Income From other source which interest on Bank Deposit. suet /~Kdl sgcieu weaell ly AU! ds Sve sles eal Putpose of certificate of income and where tobe | produced :- €. wists etl mu Bg ME MEDD ANY A ey seat) B Rell Rare = ’ | had applied /not applied fara certificate on income in the 20. A UOUG ouetse EMC HIE BRD SdAD/ RA teat Yours faithfully sawed Quy Signature of the Applicant / aaveiz-ll x Enel :- Sworn Affidavit / declaration about income from all sources. cllstge- Astestnj / oadtdl we uel ysl sue at 2y Seq Page 2 0f2