This is a reference format, not legal advice. The income threshold that defines "dependent" and the exact document required varies by employer/scheme - check your specific department's or scheme's rules before submitting.
When You Need This
Medical reimbursement (CGHS/CS(MA)), income tax dependent claims, pension dependency certificates, and compassionate appointment claims all commonly ask for a self-declaration confirming a family member is financially dependent on you. Pick the purpose that matches yours below.
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Answer a few quick questions - we'll generate a properly worded affidavit below.
Click anywhere in the document above to fine-tune the wording before printing, and add your signature below.
← Edit DetailsHow to Use This Format
- Generate the document, then use "Add Signature" to draw or upload your signature.
- Check the exact income threshold that defines "dependent" for your specific scheme/department before submitting.
- Print it, get it notarized/attested as required, and attach it to your reimbursement, tax, pension, or appointment application.
Frequently Asked Questions
A sworn declaration confirming a family member is wholly or mainly dependent on you financially - used for medical reimbursement, income tax dependent declarations, pension dependency certificates, and compassionate appointment claims.
Most schemes define a dependent as a family member whose own income is below a specified threshold. This threshold varies by employer, scheme, and purpose - check the exact income limit that applies to your specific claim.
A declaration (often combined with this affidavit) confirming a parent or other listed dependent's income falls within the limit prescribed by the employee's department, required for medical reimbursement (CGHS/CS(MA)) and other dependent-linked benefits.
Yes - compassionate appointment schemes typically require the claimant to declare which family members were dependent on the deceased/incapacitated employee, including a dependent brother or sister where applicable. The appointing authority's own eligibility rules still govern the claim itself.