Annexure : III
FORM – B
(FOR USE BY THOSE GUARDIANS WHO ARE NOT IN EMPLOYMENT ANYWHERE
AND DOES NOT DERIVE INCOME FROM SALARY/PENSION)
I, Shri/Smt. _______________________________________________ a resident of
________________________________________________________________________
solemnly declare that :
2. My son/daughter Mr/Miss ____________________________________________ is currently studying at the National Institute of Technology, Meghalaya, in 4-year B.Tech Programme, in the Branch of _______________________________________
3. I declare that my spouse is employed/not employed and that the Annual Income of my family in the Financial Year ___________________ i.e. during the period from 1st April, ___________ to 31st March, ________________ was as mentioned hereunder
(Supported by document) :
(A) From my own profession as indicated: |
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i) Income from Business/Medical practice/Legal Practice/Engineering /Consultancy etc. |
Rs._____________________p.a. |
ii) Income from Agriculture |
Rs._____________________p.a. |
iii) Income from Landed Properties |
Rs._____________________p.a. |
iv) Income from Investment in Bank/Post Office |
Rs._____________________p.a. |
v) Income from Share Certificates/Debentures |
Rs._____________________p.a. |
vi) Income from any other sources(i.e. Retirement Benefits for VRS/VSS etc., if any) |
Rs._____________________p.a. |
(B) Income of my wife/husband (if any) |
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( if employed, Salary certificate from Employer to be enclosed) |
Rs._____________________p.a. |
(C) Income in the name of my son/ward (if any) |
Rs._____________________p.a. |
GROSS TOTAL INCOME (A+B+C) : |
Further, I declare that the information given above is true. I shall also be personally held responsible in the event of any information or documents provided by me are found to be incorrect/false.
Date : |
Signature of the Father /Guardian |
: |
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Full Name |
: |
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Address with Pin Code |
: |
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Phone No. & e-mail ID |
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