APPLICATION FOR ECONOMICALLY WEAKER SECTIONS
APPLICANT DETAILS:
Applicant Name*
Relationship: (S/O,D/O,W/O) *
Gender (M/F/TG)*
Date of Birth
Mobile No*:
Phone No:
Email ID:
Aadhaar No*:
Ration Card No:
Caste*:
Purpose of Income Certificate*:
(Civil Posts & Services/ Admission
Educational Institution)
PERMANENT ADDRESS:
Door No
Locality / Land Mark
District*
Mandal*
Village*
Post Office*
Pin Code*
:
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in
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SOURCE OF INCOME:
Income from Employment:
Enter below details if Available:
Sl.
Name of
Relationship
No
the
with the
employee
applicant
1
2
Available
Employer
Details
Not Available
Whether State /Central /public
Sectors / private Sector org.
Place of
Working
Annual
Income
Name & Address of Firm /
Company / Organization etc.,
Nature of
Business
Annual
Income
Income from Business / Profession, etc.:
Enter below details if Available:
Sl. Name of the employee Relationship with
No
with designation
the applicant
1
2
Declaration:
I hereby declare that my family income from all sources for the financial year prior to the year of
application is below Rs. 8 Lakhs.
I hereby declare that the above mentioned information is furnished on best of my knowledge. If
information & declaration is found false, I am liable for prosecution.
Documents List:
1. Application Form *(PDF Format)
2. Ration Card/Aadhaar Card/EPIC Card *(PDF Format)
3. Recent Passport Size Photograph * (JGEG Format)
4. Signature of the Parent / Guardian *(JGEG Format)
5. Applicant Signature *(JGEG Format)
Yours faithfully,
Name of the Signature
of the Parent/Guardian
(* - indicates mandatory)
(Signature of the Applicant)
Note:
1. As per the Director, Ministry of Personnel, Public Grievances and Pensions, Department of
Personnel and Training, New Delhi, Government of India Memo. No. 36039/1/2019-Estt (Res)
even Dated: 21.01.2019 and 31.01.2019, “the property held by a “Family” in different
locations/places/cities shall be clubbed to determine the E.W.S. status”.
2. If it is found that the information submitted by the Applicant is fake/false, further action shall be
taken against him/her under the provision of Indian Penal Code.
3. Income covered all sources i.e., salary, agriculture, business, profession, etc.
4. The term “Family “ for this purpose will include the person, who seeks benefit of reservation,
his/her parents and siblings below the age of 18 years as also his/her spouse and children below
the age of 18 years.