Income Certificate Format - 2021

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भारतीय प्रौद्योगिकी संस्थान िुवाहाटी

गवु ाहाटी - 781 039


Indian Institute of Technology Guwahati
Guwahati – 781 039, INDIA

FORMAT OF FAMILY INCOME CERTIFICAT FOR AVAILING TUITION FEE


WAIVER BENEFIT

Certificate No.:

This is to certify that Mr./Ms. ……………….………………………………………. ……….


(Father/Mother/Guardian)
Father/Mother/ Guardian of ……………………………………………………… is a resident
(Student name and Roll No.)
of Vill/Town ………………………………….. P.O. ………………..………….………P.S. .
……………………………………. Mouja/Taluk …………………………………………
District ………………….………..……. his/her family annual income from all sources is Rs.
……………………. (Rupees………………………………..……………………….).
Income from :
Relation Profession Amount
a) Father’s Income : ………………….. : Rs …………………..
b) Mother’s Income :…….…………….. : Rs. …………………
c) Guardian’s Income : ………………….. :Rs. …………………
e) Other sources : ………………….. : Rs. ………………….

Gross Total Income = Rs.__________________

This Certificate is issued for the financial year 2020-21.


Date:
……………………………….
Signature with Seal
Name_______________________
Designation__________________
Contact No./ Email:

The Income Certificate issued ‘by any one of the following authorities’ in the prescribed
format as given above shall only be accepted as proof of candidate’s claim for availing tuition
fee waiver:

(i) District Magistrate/Additional District Magistrate/Collector/Deputy


Commissioner/Additional Deputy Commissioner/1st Class
Stipendiary Magistrate/Sub-Divisional Magistrate/Taluka
Magistrate/Executive Magistrate/Extra Assistant Commissioner
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency
Magistrate
(iii) Revenue Officer not below the rank of Tehsildar and
(iv) Sub-Divisional Officer of the area where the candidate and/or his family
normally resides.

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