Application Form For A Certificate For Eligibility (Page 3 of 3) in pdf

Application Form For A Certificate For Eligibility Page 3

Page 3

(iv )

Percentage of irrigated land holding to statutory ceiling

limit under state land ceiling laws

( v )

If land holding is both irrigated/ unirrigated total

irrigated land holding on the basis of conversion

formula in State land Ceiling Law

( vi)

Percentage of total irrigated land holding to statutory ceiling as

per (iv)

( B ) Plantation :

(i)

Crops/ Fruits

(ii)

Location

(iii)

Area of Plantation

( C ) Vacant Land and /or building in Urban agglomeration

( a ) Location of Property

( b ) Details of Property

( c ) Use to which it is put

( G ) Income / Wealth

( i)

Annual Family Income from all Sources

(Excluding salaries & Income from Agricultural Land )

(ii )

Whether Tax Payer (Yes / No)

(If yes a copy of last three year to be finished)

(iii)

Wheather covered in Wealth Tax Act (Yes/No)

(if so furnish details)

13. Any other remarks

14. Certify that above said particulars are true to the best of my knowledge and belief

and that I do not belong to the creamy layer of OBC’s and eligible to be

considered for posts reserved for OBC’s. In any event of my information being

found false or incorrect, or ineligibility being detected before or after the selection.

I undersigned that my candidate/ appointment it liable to be cancelled and I shall

be liable to such further action a may be provided under the law and or Rules.

Signature of the Candidate

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Application Form For A Certificate For Eligibility Page 3