FORMAT FOR CERTIFICATE TO BE PRODUCED BY CANDIDATES APPLYING UNDER

THE OBC CATEGORY

This is to certify that_________________, son/daughter of __________________________, of village_______________

District/Division ______________ in the State of ________________belongs to the ____________community which is recognized as a
Backward Class under the following resolution of Government of India, Ministry of Welfare.

*(i) Resolution No. 12011/68/93-BCC (C), dated the 10th September, 1993, published in the Gazette of India,
Extraordinary, Part-I, Section I, No. 186, dated the 13th September,1993.
*(ii) Resolution No. 12011/9/94-BCC, dated the 19th October, 1994, published in the Gazette of India,
Extraordinary, Part-I, Section I, No. 163, dated the 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 the 25th May,1995.
*(iv) Resolution No. 12011/44/96-BCC, dated the 6th December, 1996,published in the Gazette of India,
Extraordinary, Part-I, Section I, No. 210, dated the 11th December, 1996.
*(v) Resolution No. 12011/96/94-BCC, dated 9th March 1996.
*(vi) Resolution No. 12011/13/97-BCC, dated 3rd December 1997.
*(vii) Resolution No. 12011/99/94-BCC, dated 11th December 1997.
*(viii) Resolution No. 12011/68/98-BCC, dated 27th December 1999.
*(ix) Resolution No. 12011/88/98-BCC, dated 6th December 1999 published in the Gazette of India,
Extraordinary, Part-I, Section I, No. 270 dated 6th December 1999.
*(x) Resolution No. 12011/36/99-BCC, dated 4th April 2000 published in the Gazette of India, Extraordinary,
Part-I, Section I, No.71 dated 4th April 2000.
*(xi) Resolution No. 12011/44/99-BCC dated 21st September 2000 published in the Gazette of India,
Extraordinary, Part-I, Section I, No.210 dated 21st September 2000.
*(xii) Resolution No. 12015/9/2000-BCC, dated 6th September 2001.
*(xiii) Resolution No. 12011/1/2001-BCC, dated 19th June 2003.
*(xiv) Resolution No. 12011/4/2000-BCC, dated 13th January 2004.
*(xv) Resolution No. 12011/9/2004-BCC dated 16th January 2006 in the Gazette of India, Extraordinary, Part-I,
Section I, No. 210 dated 16th January 2006.

*Shri _____________________and /or his/her 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 and Training, O.M.
No.36012/22/93/-Est. (SCT), dated 08-09-1993 which is modified vide OM NO. 36033/3/3004 Est. (Res) dated
09/03/2004.

District Magistrate
Deputy Commissioner, etc.

Dated SEAL

*Strike out whichever is not applicable

Note:
(a) The term ‘ordinarily’ used here will have the same meaning as in Section 20 of the Representation of the
People’s Act, 1950.
(b) The authorities competent to issue caste certificates are indicated below:-
(i) District Magistrate/Additional Magistrate/Collector/Deputy Commissioner/Additional Deputy
Commissioner/Deputy Collector/First Class Stipendiary Magistrate/Sub-Divisional Magistrate/
Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner (not below the rank of
first-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.

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 FORMAT FOR CASTE/TRIBE CERTIFICATE TO BE PRODUCED BY THE
CANDIDATES APPLYING UNDER SC/ST CATEGORY

Form of Certificate as prescribed in M.H.A, O.M. No. 42/21/49-N.G.S., dated 28-1-1952 as revised in Dept. of Per.
&A.R., Letter No. 36012/6/76-Est. (S.C.T.), dated 29-10-1977, to be produced by a candidate belonging to a
Scheduled Caste or Scheduled Tribe in support of his claim.

1) This is to certify that Shri/Shrimati*/Kumari*_____________________Son/daughter* of Shri /Shrimati

__________________of village/town*__________________________________ in District/ Division*____________________________________
of the State/Union Territory* _______________ belongs to the _____________________________Caste/Tribe*which is recognized
as a Scheduled Caste / Scheduled Tribe*

Under:
*The Constitution (Scheduled Castes) Order, 1950.
*The Constitution (Scheduled Tribe) Order, 1950.
*The Constitution (Scheduled Castes) (Union Territories) Order, 1951.
*The Constitution (Scheduled Tribe) (Union Territories) Order, 1951.
(As amended by the Scheduled Castes and Schedules Tribes Lists (Modification Order) 1956, the Bombay
Reorganization Act, 1960, the Punjab Reorganization Act, 1966 the State of Himachal Pradesh Act, 1970, the North-
Eastern Areas (Reorganization) Act, 1971 and the Scheduled Castes and Schedules Tribes Orders (Amendment) Act,
1976).

*The Constitution (Jammu and Kashmir) Scheduled Castes Order, 1956.

*The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959, as amended by the Scheduled
Castes and Scheduled Tribes Orders (Amendment) Act, 1976.
*The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962.
*The Constitution (Dadra and Nagar Haveli) Scheduled Tribe Order, 1962.
*The Constitution (Pondicherry) Scheduled castes Order, 1964.
*The Constitution (Uttar Pradesh), Scheduled Tribes Order, 1967.
*The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968.
*The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968.
*The Constitution (Nagaland) Scheduled Tribes Order, 1970.
*The Constitution (Sikkim) Scheduled Castes Order, 1978.
*The Constitution (Sikkim) Scheduled Tribes Order, 1978.
*The Constitution (Jammu and Kashmir) Scheduled Tribes Order, 1989.
*The Constitution (Scheduled Castes) Order (Amendment) Act, 1990.
*The Constitution (Scheduled Tribes) Order Amendment Act, 1991.
*The Constitution (Scheduled Tribes) Order Second Amendment Act, 1991.

2) This certificate is issued on the basis of the Scheduled Castes /Scheduled Tribes Certificate issued to
Shri/Shrimati*___________________________________father/mother* of Shri/Shrimati/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 the

village/town*____________________of _________________District/Division* of the State/Union Territory* of___________________

Place______________ Signature

Date______________ __________________________

Designation________________
(With seal of Office)
__________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.

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 PWD CERTIFICATE FORMAT

Format for Physically Challenged (PH)/Persons with Disabilities (PWD)

Certificate (To be obtained by the candidate)

(To be filled by Medical Board notified under PWD Act)

Affix here recent

Photograph
showing the
disability duly
attested by Medical
Certificate No:
Superintendent/CM
O/Head of Hospital
Date:
(with Seal)

This is to certify that Mr./Ms___________________________son/daughter of Mr./Mrs._____________________________________________

Age__________male/female, Registration No._______________________ is a case of _____________________. He/She is physically
disabled/visual disabled/speech and hearing disabled/having mental retardation/ leprosy cured and has %
(_________________________per cent) permanent (physical impairment/visual impairment/speech and hearing
impairment etc.) in relation to his/her_____________________________________________.

Note:

This condition is progressive/not progressive/likely to improve/not likely to improve*.

1. Re-assessment is not recommended/ is recommended after a period of___________ months / years*.

(*Strike out whichever is not applicable)

Signature of Dr. Signature of Dr. Signature of Dr.

Name of Dr. Name of Dr. Name of Dr.

Specialization Specialization Specialization

Seal with Degree Seal with Degree Seal with Degree

(Member/Medical Board) (Member/Medical Board) (Member/Medical Board)

Signature/Thumb impression of Patient

Countersigned by the

Medical Superintendent/CMO/Head of Hospital (with seal)

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 EWS CERTIFICATE FORMAT

Government of……………………………
(Name & Address of the authority issuing the certificate)

INCOME & ASSEST CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER

SECTIONS

Certificate No. _____________________________ Date:_______________

VALID FOR THE YEAR_______________________

This is to certify that Shri/Smt./Kumari _________________________son/daughter/wife

of_____________________permanent resident of_____________________, Village/Street_______________Post.
Office_______________ District_____________ in the State/Union Territory__________________________Pin
Code____________ whose photograph is attested below belongs to Economically Weaker Sections, since the
gross annual income* of his/her family** is below Rs. 8 lakh (Rupees Eight Lakh only) for the financial
year_______________. His/her family does not own or possess any of the following assets*** :
I. 5 acres of agricultural land and above;
II. Residential flat of 1000 sq. ft. and above;
III. Residential plot of 100 sq. yards and above in notified municipalities;
IV. Residential plot of 200 sq. yards and above in. areas other than the notified municipalities.
2. Shri/Smt./Kumari__________________________belongs to the __________caste which is not recognized as a
Scheduled Caste, Scheduled Tribe and Other Backward Classes (Central List).

Recent Passport
size
Signature with seal of Office________________
attested Name_____________________
photograph of Designation__________________
the applicant

_________________________________________________________________________________________________________________________
*Note 1: Income covered all sources i.e. salary, agriculture, business, profession, etc.

**Note 2: The term 'Family" for this purpose include the person, who seeks benefit of reservation, his/her parents and siblings
below the age of 18 years as also his/her spouse and children below the age of I8 years

***Note 3: The property held by a "Family' in different locations or different places/cities have been clubbed while applying the land
or property holding test to determine EWS status.

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