Annexure-I

Income Certificate Form

(to be attached in original with application)

I certify to the best of my knowledge that the average monthly income in the preceding
year ending 31st March, 2014 from all sources (i) of the employed applicant
Shri/Smt./Km..................................................................... of village ................................ Tehsil, District,
.......................................... was Rs...................... per month
(ii) of his/her father/Mother/Spouse/guardian*
Shri/Smt./Km.* ......................................................was Rs..................... per month. I further certify that
Shri/Smt./Km.*............................................................. (applicant) is a citizen of India.

(Signature of competent authority)**
Designation**/Address
Date/Place Seal of Office

NOTE:

1. The salary of the applicant (if employed) or of his parents/guardians, if the applicant
is unemployed, including the income, if any, from the landed property of other sources
after deducting rebatable items as per income tax assessment has to be taken into
account in declaring the income; (any scholarship or fellowship which the applicant may
be receiving is not to be treated as a salary and may, therefore be excluded). In case of
salaried class, Conveyance Allowance, Overtime Allowance, and rent-free
accommodation shall not be included in determining the income, Deputation Allowance,
Honoraria for undertaking other work, Special Pay and Bonus etc. shall however be
treated as income.

2. So long as either of the parents is alive, the total income of the living parents, or if
supported by guardian (s), the total income of the g
uardian (s) has to be specified in
case of unemployed candidate.

3. In case the applicant is self-supporting or is himself/herself the head of the family,
the total income of the applicant and of his/her spouse has to be specified.

* Score out that which is not applicable.

** The income certificate may be signed by one of the following as the case may be:-
(i) The Official Superior or head of the Department in cases where the
parents/guardian(s)/applicant is in Govt. Service; (ii) The employer, in case of parents
/guardian(s)/applicant in private employment; (iii) Competent gazetted officer of
Government in case of parents/guardian (s)/applicant in private, not in regular service;
and (iv) A gazetted officer of the Revenue of Sales Tax Department in the case of
parents/guardians (s)/ applicant who are agriculturists or merchants.








Annexure-II

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING
FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA
This is to certify that Shri/Smt./Kumari---------------------------------------------------------------
son/daughter of ------------------------------------------------------------of village/town-------------------
in District/Division------------------------in the State/Union Territory-----------------------------------
belongs to the -----------------------------------------community which is recognised as a backward
class under the Government of India, Ministry of Social Justice and Empowerments
Resolution No.------------------------------------------dated----------------------*. Shri/Smt./Kumari----
----------------------------------------------- and/or his/her family ordinarily reside(s) in the ----------
----------------------District/Division of the ---------------------------------State/Union Territory. This
is also to certify that he/she does not belong to the persons/sections (Creamy Layer)
mentioned in Column 3 of the Schedule to the Government of India, Department of Personnel
& Training O.M. No. 36012/22/93-Estt.(SCT) dated 8.9.1993**.

District Magistrate
Deputy Commissioner etc.

Dated:

Seal
------------------------------------------------------------------------------------------------------------------------
---*-The authority issuing the certificate may have to mention the details of Resolution of
Government of India, in which the caste of the candidate is mentioned as OBC.
**-As amended from time to time.
Note:-The term Ordinarily used here will have the same meaning as in Section 20 of the
Representation of the People Act, 1950.


******