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 Annexure-i
Government of Rajasthan
(Name & Address of the authority issuing the certificate)
INCOME & ASSEST CERT IFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER SECTIONS
Certificate No. date:

:::::::1 ::11 :i::

*::f:::1"*;;;i VALID FOR THE YEAR

;;;il;i ;i :-:: : - :::*11::$lll5yJgi,":[

.......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 hisher
lfamily "n*is- below Rs. 8(Rupees Eight Lakh only) for the financial year.......................
His/her family does not own orpossess any of the following assets***:

l. 5 acres of agricultural land and above;

1. Residential flat of 1000 sq. ft. and above;
ll. Residential plot of 100 sq. yards and above in notified municipalities; .
lV. Residential plot of 200 sq. yards and above in areas other than the notified municipalities.
2.Shri/Smt./Kumari. the......
belongs to caste
which is not
recognized as a Scheduled Caste, Scheduled Tribe and Other Backward Classes (Central List)
This certificate is recognizedfor Centre.
Recent
Passport size
attested
photograph of
the applicant

Signature with seal of

Office.
Name.

Designation

"Note1. lncome covered all sourcesi.e. salary,agriculture, business, profession, etc

Note2.The term "Family" for this purpose include the person, who seeks benefit of reservation, his/her
parents and siblings below the ageof 18 years as also hiVher spouse and children below the ageof
lSyears
Note 3:The property held by a'Family" in different locations or different places cities have been clubbed
while applying the land or property holding test to determine EWS status.
Note 4: This certificate is in relation to office memorandum number 360391112019&ESTT(RES) date
31-01-2019 & F No:12-412019 U1 date 17-01-2A19 issued by department of personnel and Training,
Ministry of personnel, public grievances and pensions, and Department of Higher Education,
Ministryof Human ResourceDevelopment.
 Annexure-2
Government of Rajasthan
(Name & Address of the authority issuing the certificate)
INCOME & ASSEST CERT IFICATE 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 .....Mllage/Street

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 "*nis below Rs.
8(Rupees Eight Lakh only) for thefinancial
year........ His/her family does not own orpossess any of the following assets*** :

l. 5 acres of agricultural land and above;

1. Residential flat of 1000 sq. ft. and above;

ll. Residential plot of 100 sq. yards and above in notified municipalities; .

lV. Residential plot of 200 sq. yards and above in areas other than the notified municipalities.

2.Shrilsmt./Kumari. belongs to the...... caste

which is not
recognized asa Scheduled Caste, Scheduled Tribe and Other Bacl<ward Ctasses (Central /State List).
This certificate is recognizedfor both Centre /State of Rajasthan.
Recent
Passport size
attested
photograph of
the applicant

Signature with seal of

Office.
Name.
Designation

"Note1. lncome covered all sourcesi.e. salary,agriculture, business, profession, etc

Note2.The term "Family" for this purpose include the person, who seeks benefit of reservation, his/her
parents and siblings below the ageof 18 years as also his/her spouse and children below the ageof
lSyears
Note 3:The property held by a'Family" in different locations or different places cities have been clubbed
while applying the land or property holding test to determine EW$ status.
Note 4: This certificate is in relation both (a) office memorandum number 360391112019&ESTT(RES)
date31-01-2019& F No:12412019 U1 date 17-01-2019 issued by department of personnel and Training,
Ministry of personnel, public grievances and pensions, and Department of Higher Education, Ministry of
Human Resource Development. (b) F TlllDOPlA-1112019 date 19-02-19 and F TlllDOPlA-lllzO19 dated
22-02-2019 issued by Department Of personnel, Government of Rajasthan.
 i l,!r rr' !!Frr?

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