FORMATOFCASTECERTIFICATETOBESUBMITTEDBYSC/STAPPLICANTS

Form of Certificate as prescribed in M.H.A., OM.No.42/21/49N.G.S., dated 28.01.1952 as

revised in Dept. of Per. & A.R., Letter No.36012/6/76Estt.(S.C.T.) dated 29.10.1977, to be
producedbyacandidatebelongingtoaScheduledCasteorScheduledTribeinsupportofthe
claim.

FORMOFCASTECERTIFICATE

This
is
to
certify
that
Shri/Shrimathi/Kumari*

_________________________________________________son/daughter*ofShri
Village
/
Town*
_______________________________________________________
of
______________________________inDistrict/Division*_______________________oftheState/Union
Territory*of__________________________belongstothe___________________
Caste/Tribe*whichisrecognisedasaScheduledCaste/ScheduledTribe*under:

*TheConstitution(ScheduledCastes)Order,1950.

*TheConstitution(ScheduledTribes)Order,1950.
*TheConstitution(ScheduledCastes)(UnionTerritories)Order,1951.
*TheConstitution(ScheduledTribes)(UnionTerritories)Order,1951.

[(As amended by the Scheduled Castes & Scheduled Tribes Lists (Modification
Order) 1956, the Bombay Reorganisation Act, 1960, the Punjab Reorganisation Act,
1966,theStateofHimachalPradeshAct,1970,theNorthEasternAreas(Reorganisation
Act, 1971 and the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act,
1976.]

*TheConstitution(Jammu&Kashmir)ScheduledCastesOrder,1956

*The Constitution (Andaman & Nicobar Islands) Scheduled Tribes Order, 1959, as
amended by the Scheduled Castes & Scheduled Tribes Orders (Amendment Act,
1976)
*TheConstitution(Dadra&NagarHaveli)ScheduledCastesOrder,1962
*TheConstitution(Dadra&NagarHaveli)ScheduledTribesOrder,1962
*TheConstitution(Pondicherry)ScheduledCastesOrder,1964
*TheConstitution(UttarPradesh)ScheduledTribesOrder,1967
*TheConstitution(Goa,Daman&Diu)ScheduledCastesOrder,1968
*TheConstitution(Goa,Daman&Diu)ScheduledTribesOrder,1968
*TheConstitution(Nagaland)ScheduledTribesOrder,1970
*TheConstitution(Sikkim)ScheduledCastesOrder,1978
*TheConstitution(Sikkim)ScheduledCastesTribes,1978
*TheConstitution(Jammu&Kashmir)ScheduledTribesOrder,1989
*TheConstitution(ScheduledCastes)Orders(Amendment)Act,1990
*TheConstitution(ScheduledTribes)Order(Amendment)Act,1991
*TheConstitution(ScheduledTribes)OrderSecondAmendmentAct,1991

2. ApplicableinthecaseofScheduledCastes/ScheduledTribespersonswhohave
migratedfromtheState/UnionTerritoryAdministration.

ThisCertificateisissuedonthebasisoftheScheduledCastes/Scheduled

Tribes Certificate issued to Shri / Shrimathi* ________________________________, father/

mother* of Shri / Shrimathi / Kumari* ________________________________ of Village /
Town*_______________________inDistrict/Division*_______________________of
theState/UnionTerritory*of__________________________whobelongtothe
Caste / Tribe* which is recognised as a Scheduled Caster / Scheduled Tribe* in the
State/UnionTerritoryof_______________________issuedbythe_________________,
dated__________________.
3. Shri / Shrimati / Kumari* _______________________ and / or* his / her* family
ordinarilyreside(s)inVillage/Town*_______________________
oftheState/UnionTerritory*of_____________________________.

SEALOF
OFFICE

Signature: ___________________________
Designation:___________________________

PLACE:__________________
STATE/UNIONTERRITORY:_____________

DATE:__________________

NOTE. The term "Ordinarily resides" used here will have the same meaning as in
Section20oftheRepresentationofthePeoplesAct,1950.

*Pleasedeletethewordswhicharenotapplicable.

Theauthoritiescompetenttoissuecastecertificateareindicatedbelow:

(i) District Magistrate / Additional Magistrate / Collector / Deputy Commissioner /

Additional Deputy Commissioner / Deputy Collector / Fist Class Stipendiary
Magistrate/SubDivisionalMagistrate/TalukaMagistrate/ExecutiveMagistrate

/ Extra Assistant Commissioner (not below the rank of First Class Stipendiary
Magistrate).

(ii) ChiefPresidencyMagistrate/AdditionalChiefPresidencyMagistrate/Presidency
Magistrate.

(iii) RevenueOfficernotbelowtherankofTahsildar;and

(iv) SubDivisionalOfficeroftheareawherethecandidate&/orhisfamilyresides.