INCOME DECLARATION FORM

Name of the Student N SUNIL KUMAR

2.

3.

(a)
(b)
(c)

(i) Name of the Father

N SRINIVAS (LATE)

4.

(ii) Whether Employed

(iii)
if
employed,
Designation
(iv) Salary per month

---

(i) Name of the Mother

N SARASWATHI

(ii) Whether Employed

(iii)
if
employed,
Designation
(iv) Salary per month
Agricultural holding of the
parents mention extent
(i) In the name of the
Father
(ii) In the name of the
Mother
Crops Grown in land

NO
HOUSE WIFE

7.

Whether Dry or Wet land

Annual
Income
from
Agricultural Land

5.
--

6.

Business mention the trade/name of

business
Income derived from the venture
(i) No. of Vehicles owned by the Family

(ii) Whether used for personal/private

use only
(iii) Mention type of vehicles (two
wheeler/ three wheeler/four wheeler)
(iv) Vehicle registered on whose name
(i) Type of House: Mention whether
RCC, thatched/Tiled roofed
(ii) Mention whether Indiramma House
(iii) Cost of Construction of House

(iv) Whether Constructed with loan, if

so amount and Bank Branch
(v) Any other type of house

(i) Whether living in own house or

rented house
(ii) if rented, mention rent amount
Telephone / Mobile Number

OWN

--

Regd. No.
ROOFED
-

9550905037

9.
Total Family income from all sources.
600000/I hereby declare that the above information given is true & correct. I will be held liable for any wrong information given which shall include
cancellation of scholarship, recovery of amounts paid already if any besides criminal action.
Name & Signature of the Student N SUNIL KUMAR
EPASS Application ID (2014-15): 201403847828
Course: DEGREE Course Year: 3RD YEAR
College: AVANTHI DEGREE COLLEGE
College District: HYDERABAD
Mobile No: 8121217294

Name & Signature of the Parent N. SRINIVAS

Address: H.No.: 11-3-664/287
Village & Mandal: PARSIGUTTA MUSHEERABAD
City & District: HYDERABAD
Mobile No: 8121217294