Application Form Recent
For passport size
Economically Weaker Section Income attested
Certificate for the Financial Year………………… photograph of
the applicant
Applicant Details:
Applicant Name*:
Father Name*:
Gender*: Date of Birth:
Aadhar Number (optional):
Caste Category*: Sub Caste Category*:
Present Address:
Door No*: Locality/Landmark:
Vill. / Town: P.O*: Dist*: Pincode*:
State*:
Postal Address is same as Permanent Address:
Door No.*: Locality/Landmark:
Vill. / Town*: P.O*: Dist.*: Pincode*:
State*:
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/Aadhar 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 and declaration is found false, I am liable for prosecution.
I don’t belong to SC, ST and OBC Caste.
* Represents all the fields are mandatory.
……………………………………………………….
Date:…………………………. Signature of the Applicant