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Application Form For Economically Weaker Section (EWS) Income Certificate

Application Form  For Economically Weaker Section (EWS) Income Certificate * Affix Your Passport Size Photo Here   A

Extension of benefit of reservation of EWS in engagement of Trade Apprentice: BPMS writes to PMO
Form-XII – Income Aassest EWS – Certificate to be Produced by Economically Weaker Sections
‘केंद्रीय शैक्षिक संस्थाान (शिक्षक संवर्ग में आरक्षण) विधेयक, 2019
Application Form  For Economically Weaker Section (EWS) Income Certificate

* Affix Your
Passport
Size Photo
Here
 

Application Form 

For
Economically Weaker Section Income Certificate 
For the Financial year ________



Applicant Details:

Applicant Name*: Father Name*:
Gender*: Date of Birth:
Aadhaar Number (optional):
Caste Category*: Sub Caste Category*:



Present Address:

Door No*: Locality/Landmark:
State*:
District*: Mandal*: Village*: Pincode*:


Postal Address is same as Permanent Address:

Door No*: Locality/Landmark:
State*:
District*: Mandal*: Village*: Pincode*:
Mobile Number*: Mail Id:
Ration Card Number:

Income Details*:

Gross Annual Income includes Salary, Agriculture, Business, Profession etc., for
the financial year prior to the year of application (Applicant/His/Her Family*):
_________________ (In Rupees)

Assets Information (Applicant/ His/Her/Family*):

i) 5 Acres of agricultural Land and above : Yes/No
ii) Residential flat of 1000 sq. ft. and above: Yes/No
iii) Residential plot of 100 sq. yards and above in notified municipalities:
Yes/No

iv) Residential plot of 200 sq. yards and above in areas other than the notified
municipalities: Yes/No
 

Note: The term “Family“ for this purpose will 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.


Documents to be uploaded:

i) Application Form*
ii) Ration Card/Epic Card/Aadhaar Card*
iii) Copy of IT Returns/Pay Slips (Any of other Documents)
iv) Affidavit


Note:

  • ͏ I hereby declare that the above mentioned information is furnished on best of
    my knowledge. If information & declaration is found false, I am liable for
    prosecution.
  • I don’t belong to SC, ST and BC/OBC Caste.

* Represents all the fields are mandatory.

Date: Signature of the Applicant
application-form-ews-certificate-page1

Disclaimer: This application form has been issued by Andhra
Pradesh Govt other state govt authorities may use their own format.  This
form may be useful to understand the requirement of terms to get the EWS
Certificate.

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