REVENUE DEPARTMENT, GOVT.

OF NCT OF DELHI
APPLICATION FORM FOR OTHER BACKWARD CLASSES
1. AADHAAR No. :
(If AADHAAR not available, provide information of 2a and 2b)
2a.Enrolment No.: ___________________________________
Any one - PAN/Voter Card/I-Card/Passport/DL/Other-specify
2b.ID Proof No.: _____________________________________
3. Mobile No. :

1. Name of the applicant: _____________________________________________________

2. Date of Birth: _____________________________________________________________
3. Complete Residential Address
(a) Present : ____________________________________________________________
____________________________________________________________
(b) Permanent: ___________________________________________________________
____________________________________________________________
4. Religion:_________________________________________________________________
5. Caste : __________________________________________________________________
6. Sub-Caste: _______________________________________________________________
7. Occupational Group: _______________________________________________________
8. Serial Number of the Caste in the
Central List of OBCs: ______________________________________________________
9. Name of Father and address: _________________________________________________
__________________________________________________________________________
10. Name of Mother: ________________________________________________________
11. Name of Husband: _______________________________________________________
12. Status of Parent(s)/Husband: _______________________________________________
(A) Constitutional Posts
Father
Mother
Husband
I.
Designation:_______________________________________________________________________
(B) Government Service
(i) Service (Central/State:______________________________________________________
(ii) Designation:_____________________________________________________________
(iii) Scale of Pay, Including classification, if any: ____________________________________

(iv) Date of appointment to the post:___________________________________________

(v) Age at the time of promotion to Class I Post (if applicable):_______________________
II. Employment in International Organisation e.g. UN, UNICEF, WHO:
(i)

Name of Organisation:_________________________________________________

(ii)

Designation: _________________________________________________________
(Indicate date from ____________to _______________ )

(iii)

Period of Service: _____________________________________________________

III. Death/Permanent Incapacitation (Omit if not applicable)

(i) Date of death/Permanent incapacitation
Putting an officer out of service: _____________________________________________
(ii) Details of Permanent Incapacitation:__________________________________________
(C) Employment in Public Sector Undertakings etc.
(i) Name of Organisation:______________________________________________________
(ii)Designation:______________________________________________________________
(iii)Date of appointment to the Post:_____________________________________________
(D) Armed Forces including Para-military Forces
(This will not include persons holding civil posts)
(i) Designation: ______________________________________________________________
(ii) Scale of Pay:______________________________________________________________
(E) Professional class (other than those covered in item Nos. B &C)
and those engaged in trade, Business and Industry
(i) Occupation/Profession: _____________________________________________________
(F) PROPERTY OWNERS
I. Agricultural Land holding: owned by mother father & minor children
(i) Location: _________________________________________________________________
(ii) Size of holding:____________________________________________________________
(iii) (a) Irrigated (Type of irrigated land)
(i)___________________________________________________________________
(ii)___________________________________________________________________
(iii)__________________________________________________________________
(b) Unirrigated:____________________________________________________________
(iv)Percentage of irrigated land holding to statutory ceiling limit under State Land Ceiling
Laws : ___________________________________________________________________
(v) If land holding is both irrigated/unirrigated total irrigated land holdings on the bases of
Conversion formula in State Land Ceiling aw:____________________________________
(vi)Percentage of total irrigated land holding to statutory ceiling limit as per (iv):
_________________________________________________________________________
II. Plantation
(i) Crops/Fruit:_______________________________________________________________
(ii) Location:_________________________________________________________________
(iii)Area of Plantation:_________________________________________________________
III. Vacant land and/or building in urban areas or urban agglomeration
(i) Location of Property:________________________________________________________

(ii) Details of Property:_________________________________________________________

(iii)Use to which it is put :______________________________________________________

(G) Income/Wealth
(i) Annual family income from all sources (excluding salaries & income from
Agricultural land): ____________________________________________________________
(ii) Whether Tax Payer (if yes, a copy of the last three years Return be furnished)
(Yes/No): ___________________________________________________________________
(iii)Whether covered in Wealth Tax Act (if so furnish details)
(Yes/No): ___________________________________________________________________
13. Any other remarks:_______________________________________________________________
14. I certify that above said particulars are true to the best of my knowledge and belief and that I do
not belong to the Creamy Layer of OBCs and eligible to be considered for posts reserved for OBCs. In
the event of any information being found false or incorrect, or ineligibility being detected before or
after the selection, I understand that my candidature/appointment is liable to be cancelled and I shall
be liable to such further action as may be provided under the law and/or Rules.

Place

Date

Signature of the candidate

ATTESTION

I certify that Shri/Km./Smt.

.son of/daughter of/wife of
. is known to me for the last years and he/she
belongs to caste and he/she was born at
(place of birth). I also certify personally that the facts given
in this form are correct.

Signature of the Attestator

Name of Attestator (in BLOCK Letters)_________________________

Office Address with Tel no. :______________________________________

Full Residential Address:_________________________________________.

______________________________________________________

The above attestation can be done by any of the following officers:1. Member of Parliament/MLA/Councillor
2. Gazetted Officer of Delhi Govt. /Central Government.
3. Police Officer not below the rank of D.S.P.

List of supporting documents - (Maximum time limit 60 days)

Completed application form.
AADHAR No., if AADHAR No. is not available, provides the AADHAR Enrolment No. and
any one of the identity proof PAN / PASSPORT / Driving Licence / Voters Card / Identity
Card. The name of the applicant on the AADHAR card should match with the Name of the
Applicant.
The photograph of the applicant will be captured through web camera at the time of
submission of application or at the time of verification. The Photograph of the applicant
should match with photo of the applicant on the AADHAAR.
A copy of OBC certificate of father, brother, sister or of his/her blood relative from paternal
side, if available.
Two attestations by MP/MLA/ Councillor and Gazetted Officers, declaring the caste of
applicant and continuous stay in Delhi since 1993.
Family income proof (ITR / Salary slip / Form 16 etc.).
Affidavit in the prescribed Performa (Affidavit from the major if the children are below the
18 years.)
Supporting document for the present residential proof like Voters Card, Electricity Bill,
Water Bill, Telephone Bill etc.
Supporting document of residential proof in Delhi since 1993.
Note: All supporting documents must be attested by MP/MLA and gazetted officer.