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_____ ( in words also)_____. C) i declare that i /my spouse /both is/are earning member(s) in my family. Failure to complete this form may result. 1 gross wages, salaries, overtime pay, commissions, fees, tips,.
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In case this information furnished by me is found false, the financial assistance awarded to me may be recovered with penal interest and i will be liable to a legal action against me in accordance.
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If not all sections are complete there may be a delay in processing your application. The full amount of gross income earned before taxes and deductions. Self declaration statement of personal assistance. • the monthly payment amount received from social security, annuities, retirement funds, pensions, disability and other similar types of periodic payments.
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