Appendix-IV
Government of Assam
(Name & Address of the authority issuing the certificate)
INCOME & ASSET CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER SECTIONS (For seat in Educational
Institutes and posts under Govt. of Assam)
Certificate No. …………………………… Date: ………………
VALID FOR THE YEAR…………………..
This is to certify that Shri/ Smt./ Kumari………………………………………………………………………….son/daughter/wife of
………………………………………………………………………………permanent resident of ……………………………………..
…………………………..…………………..Village/Street…………………………………………..………………………...Post Office
………………....……………………... District …………….……………………..……...…………..in the State of Assam,
Pin Code…. …………… whose photograph is attested below belongs to Economically Weaker Sections, since the gross annual
income* of his/ her 'family'** is below Rs. 8 lakh ( Rupees Eight Lakh only) for the financial year ...................………His/her
family does not own or posses any of the following assets***.
I. 15 Bigha of agricultural Land and above in rural area.
II. 1 Bigha of residential land and above in rural area.
III. 1.5 Katha of land in notified Municipal Corporation/ Municipal Board/ Town Committee Area.
IV. House of built up area more than 1000 Sq.ft. and above in notified Municipal Corporation
/Municipal Board/ Town Committee area.
Shri/ Smt./ Kumari ……………………….………………………………………………………. belongs to the
………………………………………………………………..caste which is not recognized as a Scheduled Caste, Scheduled Tribe
and Other Backward Classes (in the state of Assam).
Recent Passport Signature with seal of Office…………………………………....
size attested Name…………………………………………….………………..
photograph of the
applicant Designation………………..……………………………………..
*Note 1 : Income covered all sources i.e. salary, agriculture, business, profession, etc.
**Note 2 : The term 'Family' for this purpose includes 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.
***Note 3 : The property held by 'Family' in different locations or different places / cities have been clubbed
while applying the land or property holding test to determine EWS status.
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