INCOME AFFIDAVIT
Executed at __________ on __________.
I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:
- OCCUPATION AND INCOME
1.1 My present occupation is __________.
1.2 My sources of income are: __________.
1.3 My total annual family income, from all sources, is __________.
1.4 The family members whose income is included in the figure above are: __________.
- PURPOSE
2.1 This affidavit is sworn in support of my application for an Income Certificate, needed for: __________.
2.2 I undertake to inform the issuing authority if my income changes materially before the certificate is issued, and I understand that the certificate may be withheld or cancelled if any statement made here is found false.
- DECLARATION
3.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to this application. I am aware that making a false declaration in an affidavit is an offence.
VERIFICATION
Verified at __________ on __________ that the contents of paragraphs 1 to 3 above are true and correct to my own knowledge, that no part of it is false, and that nothing material has been concealed.
DEPONENT
Signature: ______________________________
__________
ATTESTATION
Solemnly affirmed and signed before me on __________ at __________, the Deponent having been identified to my satisfaction by __________.
Notary Public / Oath Commissioner
Registration No. and seal: ____________________