AFFIDAVIT
I, ______________________________________________________________________________________________,
S/o, W/o, Sri _______________________________________________ aged about ____________ years having an occupation
of __________________________________ resident of _______________________________ D. No ___________________
Locality\Landmark _________________________________ Village / town _________________________________________
Mandal _________________________________ District ________________________________________ Pincode do hereby
solemnly affirm and state on oath as follows.
I am the deponent herein as such I am well acquainted with the facts of this affidavit. I submit that I am the resident of above
address, I am doing __________________________________________ (Profession) and getting Rs. _____________________
in Rupees ___________________________________________________________________ only per annum from all sources
mentioned below except the above said income. I belong to _________________ Caste, which comes under SC/ST/BC/Others.
The income certificate is necessary for my Son / Daughter _________________________________________________ Who is
studying _________________________________________ at _____________________ He / she required income certificate
for getting scholarship / Fee reimbursement, hence I am giving this affidavit along with income declaration.
INCOME DECLARATION
(As per G.O., RT No.1307, Rev., (Ser.II) Dept., and Dt.13.9.2010)
1
: ____________________________________________________
Date of Birth
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
10 Telephone/Mobile Number
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
14 Email
: ____________________________________________________
I shall be liable for penal action both civil and criminal, if the above facts are false in future besides recovery of the scholarship
with penal interest under the revenue recovery act. Therefore, I request the concerned revenue authorities may be pleased to
accept this affidavit and issue income certificate to my son/daughter _______________________________________________
for scholarship / fee reimbursement purpose.
The above facts are true and correct to the best of my knowledge and belief.
Date:
Place:
Solemnly affirm and signed before me at on___________
Attested by:
Signature of the Notary
SERVICES OFFERED
Sl. No.
Service
Service Level
15 Minutes *
25/-
Extract of ROR 1B
15 Minutes *
25/-
Copy of FMB
15 Minutes *
25/-
5 Days
35/-
F-Line Petitions
30 Days
35/-
Sub-Division of Lands
30 Days
35/-
45 Days
35/-
Income Certificate
35/-
Residence Certificate
35/-
10
Integrated Certificate
(Caste-Nativity-Date of Birth)
35/-
11
35/-
12
EBC Certificate
35/-
13
35/-
14
35/-
15
35/-
16
25/-
17
15 minutes
25/-
18
35/-
19
90 Days
35/-
20
Apathbandhu Scheme
10 Days
35/-
21
NFBS Application
1 Week
35/-
22
30 Days
35/-
23
35/-
24
School Registration
1 Week
35/-
25
15 Mins. (Category-A)
26
15 Mins. (Category-A)
27
6 Working Days
28
6 Working Days
29
6 Working Days
(within one year)
30
3 Working Days
NOTE :
1. Postal charges extra.
2. *Subject to availability of online digital records, otherwise the request will be processed within 7 days.
3. Printing of additional pages at ` 2/- per page.
1100
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