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Declaration

Self-Declaration of Marital & Dependent Status

A self-declaration of an individual's marital status and the family members dependent on them, for official or tax-benefit purposes.

SELF-DECLARATION OF MARITAL AND DEPENDENT STATUS

Submitted to [Employer / Insurer / Institution Name] for the purpose of records, benefit eligibility and tax deduction claims.

I, [Full Name], son/daughter of [Father's Name], holding PAN [PAN Number], residing at [Full Address], do hereby declare as under:

I hereby declare that my marital status is [Single / Married / Widowed / Divorced]. My spouse, if applicable, is [Spouse Name]. The following persons are wholly or mainly dependent on me: [Name, Relationship & Age of each Dependent - e.g., Mother, Father, Children]. I confirm that these dependents do not have independent taxable income exceeding the prescribed limit.

I make this declaration for claiming applicable benefits and deductions and undertake to intimate any change in the above particulars. The information given above is true and correct.

_____________________
[Signature of Declarant]
[Name]
Place: [Place]    Date: [DD/MM/YYYY]

Before you use it — fill in / check

  • Full Name
  • PAN Number
  • Marital Status
  • Spouse Name
  • Dependent Details

How to use this template

  1. Read through and replace every [bracketed] or blank placeholder with your actual details.
  2. Delete any clause that doesn't apply and add anything specific to your situation.
  3. Click Print / Save as PDF to download, or Copy text to paste into your letterhead.
  4. Get it signed / stamped / notarised as required, and keep a copy for your records.

This is a general, editable template for convenience only — not legal advice. For anything material, have a professional review it. TaxClue isn't liable for how it's used.