SELF EMPLOYMENT DECLARATION OF INCOME

(INFORMAL BUSINESS)

I ...
Declare as follows:
1. That I reside at
in the parish of
2. I have been self-employed as a
Since..
3. I am estimated to earn ________________________________________________
(Weekly, Fortnightly, Monthly, Annually)

4. 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

On the ______________of _________________________/ __________________

Day

month
Affix seal/stamp here

Year