GOVERNMENT OF TELANGANA
REVENUE DEPARTMENT
APPLICATION INCOME CERTIFICATE
To
The Tahsildar Photo
Mandal,
Dist Telangana. Date : / /20
Applicant Name :
Relation : S/o, D/o,W/o,H/o,F/o,C/o, withName) :
Gender: Mal / Female Date of Birth *:
ADDRESS:
Door No : Locality/ Land Mark :
District: Mandal : _________________________
Village : Pin code:
Ration Card No :
Mobile No :
AADHAAR NO :
INCOME FROM ALL SOURCES ( JOB,BUSINESS OR OTHERS ):
Income from Land and Buildings Rs.
By Business Rs.
Total Income of husband and Wife Rs.
Daily wage Earner Rs.
Income from Others Source’s Rs.
(Total Income Details)
Total : Rs.
Purpose of Certificate :
Theinformationsubmittedistrueandaccuratetothebestofmyknowledge.Ifthe information
found incorrect, legal action as deemed fit.
Parents Signature. Signature of the Applicant
DOCUMENTS :
Application Form*
Proof of Address* : Aadhaarar /EPIC Card/ Gas Bill/ Electricity Bill/ Bank Passbook/ Ration Card /Driving License/ Post Office
Account Statement/ Government-Issued Photo ID or PSU-Issued Service Photo ID Card.
Proof of Identity* : Aadhaar Card /EPIC Card or Any Other Identity Proof.
Proof of Income* : FSC Card /Copy of IT Returns /Pay Slip or Any Other Document Showing Income.
Passport Size Photo*
