Annexure - I
Goverment of …..............(Name & Address of the authority issuing the certificate)
INCOME & ASSEST CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER SECTIONS
Certificate No._________ Date:___________
VALID FOR THE YEAR___________
This is to certify that Shri/ Smt./ Kumari _______________________________________ Son/ daughter/ wife of _____________________________________________________ permanent resident of village/town/street __________________ Post Office_____________ District in the State/Union Territory__________________ Pin Code____________whose photograph is attested below belongs to Economiclly Weaker Sections, since the gross annual income* of his/her 'father”** is below Rs. 8 lakh (Rupees Eight Lakh Only) for the financial year________. His/Her 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 100 sq. yards and above in areas other than the notified municipalities.
2. Shri/Smt./Kumari____________________________________belongs to the __________ caste which is not recognised as a Scheduled Caste, Scheduled Tribe and Other Backward Classes (Central List)
Signature with Seal of Office ___________________
of the applicant
*Note1: Income covered all sources i.e. salary, agriculture, business, profession, etc.
**Note2: The term “Family” for this purpose include the person, who seeks benefit of reservation, his/her parents and siblings below the age of 18 years as also his/her spouse and children below the age of 18 years.
***Note3: The property held by a “Family” in different locations or different places/cities have been clubbed while appplying the land or property holding test to determine EWS status.
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