Form-C - Application/declaration Of The Applicant For Obtaining Income & Backward Class Certificates Page 2

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Verification by patwari
Certified
that
Shri/Shrimati/Kumari_______________Son/daughter
of______________resident
of
_______________
Tehsil________________District__________________Owns______________Bigha/Hect
cultivated
and_______________ Bigha/Hect Uncultivated land.
The annual income of the family of the applicant from all sources comes to
Rs.________________
As per the procedure laid down for calculating the family income in H.P.L.R.M.
Certified that Shri/smt./Kumari________________ holds non-agricultural property in
village/Town ________________Tehsil_____________, District, the income of which comes to Rs.
_____________ as per Certificates of income issued by various Departments/authorities.
Place: __________
Signature of Patwari.
Date: ___________

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