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  GOVERNMENT OF MANIPUR
 DEPARTMENT OF SOCIAL WELFARE
       SCHOLARSHIP FOR THE PHYSICALLY HANDICAPPED

INCOME CERTIFICATE

Vide Rule 7 (b) (iv)
I, …………………………………………………… certify to the best of my knowledge and belief that the total 
combined income from all sources of both the parents/guardian of Shri/Km./Smt. ………………………….. 
(Name of the Candidate) resident of ………………………………… is Rs. …………………./-                           (Rupees ………………………………..) p.m.


Signature of Candidate                                                                                     Signature

Date                                                                                                     Name in block letters
                                                                                                            Designation
Place                                                                                                   Office Stamp


I, father/guardian of Shri/Km./Smt. …………………………………………… undertaken to intimate to 
the Union Department of Social Welfare, any change in the above mentioned income that takes place at any 
time during the pendency of the scholarship.

Date
                                                                                                          Signature
Place                                                                                                 Profession

                                                                                                         Postal Address




N.B.: It may be given by a Revenue Officer not below the rank or Naib Tahsildar or any other officer of equivalent status or an affidavit attested by a first class Magistrate or a Certificate from a gazetted Officer of the Cenral or State Govt. or a Member of Parliament or State Legislature.