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Get India Self Declaration of Family Income Community and Institution Verification Form

SELF DECLARATION OF FAMILY INCOME COMMUNITY AND INSTITUTION VERIFICATION FORM UNDER PRE POST MATRIC SCHOLARSHIP CLASS XI AND ABOVE /MERIT-CUM-MEANS SCHOLARSHIP SCHEME OF MINISTRY OF MINORITY AFFAIRS GOVERNMENT OF INDIA I Son/Daughter/of Resident of full address affirm and declare as under a That I am citizen of India. Belongs to State b That annual income of my family from all sources is Rs in words also. c I declare that my father/mother/both is/are earning Member s in my family. 2. I certify that the above information given by me is true. 3. I am not availing any other Scholarship for this purpose from any other Central Govt*/ State Govt* source. 4. I Shall abide by the terms and conditions for sanction of the Pre /Post Matric / Merit cum Means based Scholarship* 5. In case this information furnished by me is found false the financial assistance awarded to me may be recovered with penal interest and I will be liable to a legal action against me in accordance with law. Signature of Candidate Signature of Parent/Guardian Name of Candidate Name of Parent/Guardian Verification/Information to be furnished by the Head of Institution/College It is certified that the information provided below in respect of He/She session in is correct. He/ She is a hosteller/day scholar of the Institution/College. Last year marks percentage. Fee details current Year. He / She belongs to community as per Institution / College records. For Renewal of Scholarship It is certified that the student has not changed the course of study and/or the Institution of the study for which the scholarship was originally awarded / has changed the course of study and/or institution with prior approval of the State Government Please strike out which is not applicable. my knowledge and as per information available on our records. Date Place Signature of the head of the Institution/College with official seal*. c I declare that my father/mother/both is/are earning Member s in my family. 2. I certify that the above information given by me is true. 3. I am not availing any other Scholarship for this purpose from any other Central Govt*/ State Govt* source. 3. I am not availing any other Scholarship for this purpose from any other Central Govt*/ State Govt* source. 4. I Shall abide by the terms and conditions for sanction of the Pre /Post Matric / Merit cum Means based Scholarship* 5. 4. I Shall abide by the terms and conditions for sanction of the Pre /Post Matric / Merit cum Means based Scholarship* 5. In case this information furnished by me is found false the financial assistance awarded to me may be recovered with penal interest and I will be liable to a legal action against me in accordance with law. In case this information furnished by me is found false the financial assistance awarded to me may be recovered with penal interest and I will be liable to a legal action against me in accordance with law. Signature of Candidate Signature of Parent/Guardian Name of Candidate Name of Parent/Guardian Verification/Information to be furnished by the Head of Institution/College It is certified that the information provided below in respect of He/She session in is correct. .

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