Print the below income declaration on the

Non-Judicial Stamp Paper (Rs. 10/-)

 INCOME DECLARATION FORM
Name of the Student AITHA KEERTHANA
1. (i) Name of the Father AITHA KARUNAKAR 4. Business mention the trade/name of NO
business
(ii) Whether Employed PRIVATE EMPLOYEE Income derived from the venture NO
(iii) if employed, 5. (i) No. of Vehicles owned by the Family NO
Designation
(iv) Salary per month 8000 (ii) Whether used for personal/private NO
use only
2. (i) Name of the Mother AITHA HARITHA (iii) Mention type of vehicles (two No
wheeler/ three wheeler/four wheeler)
(ii) Whether Employed HOUSE WIFE (iv) Vehicle registered on whose name NO
(iii) if employed, No 6. (i) Type of House: Mention whether RCC
Designation RCC, thatched/Tiled roofed
(iv) Salary per month NO (ii) Mention whether Indiramma House NO
3. Agricultural holding of the NO (iii) Cost of Construction of House NO
parents mention extent
(i) In the name of the NO (iv) Whether Constructed with loan, if NO
Father so amount and Bank Branch
(ii) In the name of the NO (v) Any other type of house NO
Mother
(a) Crops Grown in land NO 7. (i) Whether living in own house or OWN
rented house
(b) Whether Dry or Wet land NO (ii) if rented, mention rent amount
(c) Annual Income from NO 8 Telephone / Mobile Number 9515083045
Agricultural Land
9. Total Family income from all sources. 95000
I hereby declare that the above information given is true & correct. I will be held liable for any wrong information given
which shall include cancellation of scholarship, recovery of amounts paid already if any besides criminal action.
Name & Signature of the Student : Name & Signature of the Parent :
ePASS Application ID (2018-19):201807285088 Address: H.No 9-47 GANDHI NAGAR
Course: BE (CSE) Course Year:4TH Village : Mandal: BHUPALPALLY
College:MVSR Engg College City & District:JAYA SHANKAR BHUPALPALLY
College District: nadergul Ranga Reddy Mobile No:8790352830
Mobile No: 9515083045