migrated uni

migrated uni

 migrated from one State / Union Territory Administration. 




This certificate is issued on the basis of the Scheduled Castes / Scheduled Tribes* 

Certificate issued to Shri. / Smt. / Kumari* 

_________________________________________Father /Mother* of Sri / Smt. / 

Kumari*____________________________________________________of village / 

town ______________________in District/Division*____________________of the 

State/Union Territory*_________________________________ who belong to 

the______________________ Caste / Tribe* which is recognized as a Scheduled 

Caste/Scheduled Tribe* in the State/Union Territory* issued by the 

____________________________________[Name of the authority] vide their order 

No. ___________________________ dated _______________________. 

3.Shri/Smt/Kumari*____________________________________________and/or* 

his/her* family ordinarily reside(s) in village/town*__________________________ 

of____________________ District / Division* of the State / Union Territory* of 

_____________________ 

 

 

 Signature _____________________ 

 Designation ___________________ 

Place: [With seal of Office] 

Date: State/Union Territory 

Note: The term "Ordinarily resides" used here will have the same meaning as in Section 20 

of the Representation of the Peoples Act, 1950. 

---------------------------------------------------------------------------------------------------------------

------------ 

* Please delete the words which are not applicable. 

# Delete the paragraph which is not applicable. 

List of authorities empowered to issue Caste / Tribe Certificates: 

1. District Magistrate / Additional District Magistrate / Collector / Deputy Commissioner / 

Additional Deputy Commissioner / Deputy Collector/I Class Stipendiary Magistrate / Sub-

Divisional Magistrate / Extra-Asst. Commissioner / Taluka Magistrate / Executive Magistrate. 

2. Chief Presidency Magistrate/ Additional Chief Presidency Magistrate / presidency 

Magistrate. 

3. Revenue Officer not below the rank of Tehsildar. 

4. Sub-Divisional Officers of the area where the candidate and / or his family normally 

resides. 

5. Administrator/Secretary to Administrator/Development Officer Lakshadweep). 

Note: The Certificate is subject to amendment/modific


FORM OF CERTIFICATE TO BE PRODUCED BY 

OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT 

TO POSTS UNDER THE GOVERNMENT OF INDIA 

This is to certify that Sri/Smt./ Kumari 

________________________________________________ son/daughter of 

__________________________________ of village/Town 

____________________________District/Division _______________ in the State/ 

Union Territory________________________ belongs to the 

______________________________community which is recognized as a backward 

class under the Government of India, Ministry of Social Justice and Empowerment’s 

Resolution No. __________________ dated ___________*. Shri/Smt./Kumari 

____________________and/or his/her family ordinarily reside(s) in the 

______________________District/Division of the 

__________________________State/Union Territory. This is also to certify that he/she 

does not belong to the persons /sections (Creamy Layer) mentioned in column 3 of the 

Schedule to the Government of India, Department of Personnel & Training OM 

No.36012/22/93- Estt.[SCT], dated 8-9-1993 

Dated: 

 District Magistrate Deputy Commissioner etc. 

Seal 

* - the authority issuing the certificate may have to mention the details of Resolution of 

Government of India, in which the caste of the candidate is mentioned as OBC. 

**- As amended from time to time. 

Note: - The term “Ordinarily” used here will have the same meaning as in Section 20 of 

the Representation of the People Act, 1950. 

The Prescribed proforma shall be subject to amendment from time to time as per 

Government of India Guidelines. 21


amputation or complete permanent paralysis of limbs and in cases of

blindness) (Prescribed proforma subject to amendment from time to time)

(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)

Certificate No. : Date :

This is to certify that I have carefully examined

Shri/Smt./Kum._________________________________________________________

____son/wife/daughter of Shri

___________________________________________________ Date of Birth (DD / MM

/ YY) ____ ____ ____ Age ________ years, male/female

Registration No.

__________________________ permanent resident of House

No.______________________

Ward/Village/Street___________________________________________ Post Office

_______________________________District __________ State ____________,

whose photograph is affixed above, and am satisfied that:

(A) he/she is a case of:

 Locomotor disability

 Blindness

(Please tick as applicable)

(B) The diagnosis in his/her case is _________

(A) He/ She has ______________% (in figure) ________________________ percent (in

words) permanent physical impairment/blindness in relation to his/her _________ (part

of body) as per guidelines (to be specified)

The applicant has submitted the following documents as proof of residence:-

2. Nature of

Document

Date of Issue Details of authority issuing

certificate

 (Signature and Seal of Authorized Signatory of notified Medical

Authority)

Recent PP size

Attested

Photograph

(Showing face

only) of the

person with

disability

Signature/Thumb

impression of the

person in whose

favor disability

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