This certificate is issued on the basis of the Scheduled Castes/ Scheduled tribes certificate issued to Shri/Shrimati __________________________Father/mother _____________________________ of
Shri/Srimati/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_______________________________ ____dated____________________________.
%3. Shri/Shrimati/Kumari and /or * his/her family ordinarily reside(s) in village/town*________________________________________ of ________________ District/Division* _________________of the State/Union Territory of ____________________________
(with seal of office)
* Please delete the words which are not applicable
@ Please quote specific presidential order
% Delete the paragraph which is not applicable.
NOTE: The term ordinarily reside(s) used here will have the same meaning as in section 20 of the Representation of the People Act, 1950.
** List of authorities empowered to issue Caste/Tribe Certificates:
(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Dy.Collector/Ist Class Stipendiary Magistrate/Sub-Divisional Magistrate/Extra-Assistant Commissioner/Taluka Magistrate/Executive Magistrate.
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officers not below the rank of Tehsildar.
(iv) Sub-Divisional Officers of the area where the candidate and/or his family normally resides.
NOTE: ST candidates belonging to Tamil Nadu state should submit caste
certificate ONLY FROM THE REVENUE DIVISIONAL OFFICER.
ANNEXURE-VII (FORMAT OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE GOVERNMENT OF INDIA) This is to certify that _______________________________ son/ daughter of _________________________________________ of village _____ ______________________________ District/Division _____________________ in the ______________________________ State __________________________ ________ belongs to the ______________________ Community which is recognized as a backward class under:
i) Resolution No. 12011/68/93-BCC dated the 10th September, 1993, published in the Gazette of India Extraordinary – Part I, Section I, No. 186 dated 13th September, 1993.
ii) Resolution No. 12011/9/94-BCC, dated 19.10.1994 published in Gazette of India extraordinary Part I Section I No. 163, dated 20th October, 1994.
iii) Resolution No. 12011/7/95-BCC dated the 24th May 1995 Published in the Gazette of India extraordinary Part-I Section I No. 88 dated 25th May, 1995.
ix) Resolution No.12011/88/98-BCC dated 6th December, 1999, published in the Gazette of India, Extra Ordinary Part-I, Section-I No.270, 6th December, 1999.
x) Resolution No.12011/36/99-BCC dated 4th April, 2000, published in the Gazette of India, Extra Ordinary Part-I, Section-I, No.71 dated 4th April, 2000.
xi) Resolution No.12011/44/99-BCC dated 21.9.2000, published in the Gazette of India, Extra Ordinary Part-I, Section-I, No.210 dated 21.9.2000.
Shri ____________________________ and/or his family ordinarily reside(s) in the__________________________ District/Division of the ____ ___________________________________ State.
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 08.09.1993 and modified vide Govt. of India Deptt. of Personnel and Training OM No. 36033/3/2004-Estt(Res) dated 09.03.2004 & 14.10.2008
Dated: District Magistrate or
Deputy Commissioner etc.
Note-I (a) The term ‘Ordinarily’ used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950.
(b) The authorities competent to issue Caste Certificate are indicated below:-
(i) District Magistrate/Additional Magistrate/Collector/Dy. Commissioner/ Additional Deputy Commissioner/Deputy Collector/Ist Class Stipendary Magistrate/ Sub-Divisional Magistrate/Taluka Magistrate/ Executive Magistrate/Extra Assistant Commissioner (not below the rank of 1st Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate /Additional Chief Presidency Magistrate/ Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tehsildar
(iv) Sub-Divisional Officer of the area where the candidate and/or his family resides.
The candidate should furnish the relevant OBC Certificate in the format prescribed for Central Government jobs as per Annexure-VII issued by the competent authority. The certificate must be dated on or before the date of last Tier of Examination, subject to Para-4(C ) of the Notice.
NAME & ADDRESS OF THE INSTITUTE/Hospital Certificate No. ——————- Date——————-
DISABILITY CERTIFICATE This is certified that Shri/Smt/Kum _____________________ son/wife/daughter of Shri ________
___________ age _____________sex ______________identification mark(s) ______________
is suffering from permanent disability of following category :-
( DELETE THE CATEGORY WHICHEVER IS NOT APPLICABLE )
2. This condition is progressive/non-progressive/likely to improve/not likely to improve. Re-assessment of this case is not recommended/is recommended after a period of _____ years ____ months.*
3. Percentage of disability in his/her case is ..................... percent.
4. Sh./Smt./Kum ............................. meets the following physical requirements for discharge of his /her duties :-
(i) F-can perform work by manipulating with fingers. Yes/No
(ii) PP-can perform work by pulling and pushing. Yes/No
(iii) L-can perform work by lifting. Yes/No
(iv) KC-can perform work by kneeling and crouching. Yes/No
(v) B-can perform work by bending. Yes/No
(vi) S-can perform work by sitting. Yes/No
(vii) ST-can perform work by standing. Yes/No
(viii) W-can perform work by walking. Yes/No
(ix) SE-can perform work by seeing. Yes/No
(x) H-can perform work by hearing/speaking. Yes/No
(xi) RW-can perform work by reading and writing. Yes/No