Annexure-VIII
Government 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/ Street _____________
Post Office ___________________ District___________________in the State/ Union
Territory ___________________ Pin Code __________ whose photograph is attested
below belongs to Economically Weaker Sections, since the gross annual income* of his/
her ‘family’** 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 200 sq. yards and above in areas other than the notified
municipalities.
2. Shri/Smt./Kumari _____________________ belongs to the ______________caste
which is not recognized as a Scheduled Caste, Scheduled Tribe and Other Backward
Classes (Central List).
Signature with seal of Office_____________________________
Name____________________________________
Designation_________________________
Recent Passport size
attested photograph of
the applicant
*Note 1: Income covered all sources i.e. salary, agriculture, business,
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