FORM No.

IV
(See Rule 3)

GOVERNMENT OF ODISHA
Office of the Collector PURI
Miscellaneous Certificate Case No E-IAC/2020/02411
VALID FOR THE YEAR 2021-2022
INCOME AND ASSET CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER SECTIONS

This is to certify that Shri ANIKET DAS son of Smt GITARANI DEVI and Shri BYOMKESH DAS
permanent resident of Village/ Street MANGALA GHAT ROAD NEAR BALI SCHOOL Post Office PURI
District PURI in the State of Odisha, PinCode 752001 whose photograph is attested below belongs to
Economically Weaker Sections, since the gross annual income 355000.00 (Rs. Three Lakh Fifty Five
Thousand ) only of his "family"** is below Rs.8.00 lakh (Rupees Eight Lakh only) for the financial year
2020-2021. His family does not own or possess any of the following assets:

I. 5 acres of agricultural land and above;

II. Residential flat of 1000 sq. ft. and above;

III. Residential plot of 100 sq. yards and above in notified municipalities;

IV. Residential plot of 200 sq. yards and above in areas other than the notified municipalities;

2. Shri ANIKET DAS belongs to the caste which is not recognised as a Scheduled Caste, Scheduled Tribe
and Other Backward Class (Central List).

dgSign2031LocnDyna
Signature of the Revenue Officer
19/07/2022

**** This is a Digitally Signed Document And Does Not Require Signature ****

NOTE
(i) It is a digitally signed electronically generated certificate and therefore needs no ink-signed signature.
(ii) This Certificate is issued as per section 4, 5,& 6 of Information Technology Act 2000 and its subsequent amendments in
2008 and as per Revenue & Disaster Management Department Notification number IMU-13/10-4251/R&DM.
(iii) For any Query or Verification, Agency /Department / Office may visit https://edistrict.odisha.gov.in
(iv) Tampering of this Certificate will attract penal action.

Reference No: E-IAC/2020/02411 To View: https://edistrict.odisha.gov.in/t/BRY5c/99129D3C Token No: 99129D3C