APPLICATION FORM FOR OBTAINING INCOME CERTIFICATE FROM THE DEPUTY COMMISSIONER1. Name in full ( In block letter )DISTRICT ARUNACHAL PRADESH2. Father's/Mother's/ Guardian's Husband Name3. Present Occupation4. Village5. Circle6. For whom the certificate is required7. Total number of family members8. Income per annum with supporting affidavit from HOD/DDO9. (a) Other Land holding (b) Other Sources TOTAL PER ANNUM10. Schedule cast/ Schedule tribe11. Purpose for which certificate is soughtI declare that the particulars furnished above are true to the best of my knowldege and belief.VERIFICATIONI ShriASM of villageunderAdministrative circle verified personally and statementfurnished by the applicant are correct to the best of my knowledge and belief.Name and SignatureASM (with seal)Certified that above particulars furnished by applicant are correct to the best of my knowledge and belief.DateSignature of the concern Administrative officer of the area(with seal)Place
