INFORMATION BULLETIN: COMMON UNIVERSITY ENTRANCE TEST (UG) - 2023

Annexure- IA

Government of ………………………………….
(Name and Address of the authority issuing the certificate)

INCOME AND ASSET CERTIFICATE TO BE PRODUCED BY ECONOMICALLY

WEAKER SECTIONS

Certificate No. Date:

Valid for the year: _________________________
1. 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 in 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 2021-2023. 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 Schedule Caste, Schedule Tribe, and Other Backward Classes
(Central List).

Signature with the seal of Officer

Name __________________ Designation _________________________

The income and assets of the families as mentioned

Recent Passport size would be required to be certified by an officer not
attested photograph below the rank of Tehsildar in the States/UTs.
of the applicant

* Note1: Income covered all sources i.e. salary, agricultural, business, profession, etc.
** Note2: The term “Family” for this purpose includes the person, who seeks the
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 18 years.
*** Note3: 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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INFORMATION BULLETIN: COMMON UNIVERSITY ENTRANCE TEST (UG) - 2023

Annexure- IB

DECLARATION BY THE CANDIDATE IN LIEU OF GEN-EWS CERTIFICATE

Passport
Name of the candidate: size
Photograph
Address: of the
Candidate

Application Number of CUET 2023:

Mobile No: Email:

I understand that as per the new guideline from the Ministry of Personnel, Public
Grievances and Pensions, GoI, I am required to submit a GEN-EWS certificate issued on
or after 1 April 2022.
Since I have not been able to collect the said certificate on time, I may kindly be allowed to
write CUET (UG) - 2023 provisionally. I hereby declare that I will upload a fresh certificate
(issued on or after 1 April 2022) at the time of reporting after seat allocation.
I understand that inability to upload the same by the given date and time will lead to the
withdrawal of the GEN-EWS benefit. I also understand that, if qualified, my category will
be adjusted accordingly in the Common Rank List.

Signature of Father/Mother

Name: Date:

Signature of Applicant Date:

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 INFORMATION BULLETIN: COMMON UNIVERSITY ENTRANCE TEST (UG) - 2023

Annexure-IIA
OBC-NCL Certificate Format
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES
(NCL)* APPLYING FOR ADMISSION TO CENTRAL EDUCATIONAL INSTITUTIONS
(CEIs), UNDER THE GOVERNMENT OF INDIA
This is to certify that Shri/Smt./Kum** Son/
Daughter** of Shri/Smt.** of Village/
Town** District/Division** in
the State/Union Territory belongs to the
community that is recognized as a backward class under
Government of India***, Ministry of Social Justice and Empowerment’s Resolution No.
dated ****

Shri/Smt./Kum. 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 O.M. No. 36012/22/93- Estt. (SCT) dated
08/09/93 which is modified vide OM No. 36033/3/2004 Estt. (Res.) dated 09/03/2004, further
modified vide OM No. 36033/3/2004-Estt. (Res.) dated 14/10/2008, again further modified vide OM
No.36036/2/2013-Estt (Res) dated. 30/05/2014, and again further modified vide OM No.
36033/1/2013-Estt (Res) dated. 13/09/2017.

District Magistrate/Deputy
Commissioner /
Any other Competent Authority
Dated: Seal

* Visit http://www.ncbc.nic.in for the latest guidelines and s on the Central List of State-wise
OBCs.
** Please delete the word(s) which are not applicable.
*** As listed in the Annexure (for FORM-OBC-NCL)
**** The authority issuing the certificate needs to mention the details of the Resolution of
Government of India, in
which the caste of the candidate is mentioned as OBC.
NOTE:
(a) The term ‘Ordinarily resides’ 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 Certificates are indicated below:
(i) District Magistrate/ Additional Magistrate/ Collector/ Deputy Commissioner/
Additional Deputy Commissioner/ Deputy Collector/ Ist Class Stipendiary Magistrate/
Sub-Divisional magistrate/ Taluka Magistrate/ Executive Magistrate/ Extra Assistant
Commissioner (not below the rank of Ist Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.
(ii) Revenue Officer not below the rank of Tehsildar’ and
(iv) Sub-Divisional Officer of the area where the candidate and/or his family resides

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INFORMATION BULLETIN: COMMON UNIVERSITY ENTRANCE TEST (UG) - 2023

ANNEXURE for FORM-OBC-NCL

Sl. No. Resolution No. Date of Notification

1 No.12011/68/93-BCC(C) 13.09.1993
2 No.12011/9/94-BCC 19.10.1994
3 No.12011/7/95-BCC 24.05.1995
4 No.12011/96/94-BCC 09.03.1996
5 No.12011/44/96-BCC 11.12.1996
6 No.12011/13/97-BCC 03.12.1997
7 No.12011/99/94-BCC 11.12.1997
8 No.12011/68/98-BCC 27.10.1999
9 No.12011/88/98-BCC 06.12.1999
10 No.12011/36/99-BCC 04.04.2000
11 No.12011/44/99-BCC 21.09.2000
12 No.12015/9/2000-BCC 06.09.2001
13 No.12011/1/2001-BCC 19.06.2003
14 No.12011/4/2002-BCC 13.01.2004
15 No.12011/9/2004-BCC 16.01.2006
16 No.12011/14/2004-BCC 12.03.2007
17 No.12011/16/2007-BCC 12.10.2007
18 No.12019/6/2005-BCC 30.07.2010
19 No. 12015/2/2007-BCC 18.08.2010
20 No.12015/15/2008-BCC 16.06.2011
21 No.12015/13/2010-BC-II 08.12.2011
22 No.12015/5/2011-BC-II 17.02.2014

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INFORMATION BULLETIN: COMMON UNIVERSITY ENTRANCE TEST (UG) - 2023

Annexure- IIB

DECLARATION BY THE CANDIDATE IN LIEU OF OBC-NCL CERTIFICATE

Passport
Name of the candidate: size
Photograph
Address: of the
Candidate

Application Number of CUET 2023:

Mobile No: Email:

I understand that as per the new guideline from the Ministry of Personnel, Public
Grievances and Pensions, GoI, I am required to submit the OBC-NCL certificate
issued on or after 1 April 2022.
Since I have not been able to collect the said certificate on time, I may kindly be
allowed to write CUET (UG) - 2023 provisionally. I hereby declare that I will upload
a fresh certificate (issued on or after 1 April 2022) at the time of reporting after seat
allocation.
I understand that inability to upload the same by the given date and time will lead to
the withdrawal of the OBC-NCL benefit. I also understand that, if qualified, my
category will be adjusted accordingly in the Common Rank List.

Signature of Father/Mother

Name: Date:

Signature of Applicant Date:

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 INFORMATION BULLETIN: COMMON UNIVERSITY ENTRANCE TEST (UG) - 2023

Annexure-III
SC/ST Certificate Format

FORM OF CERTIFICATE TO BE PRODUCED BY SCHEDULED CASTES (SC) AND SCHEDULED TRIBES (ST)
CANDIDATES
1. This is to certify that Shri/ Shrimati/ Kumari* son/daughter* of
__ ____ _____ ____ _____ ____ _ of Village/Town* __ _____ ____ _____ __ District/Division*
__ ____ _____ ____ _____ ___ of State/Union Territory* belongs to the
Scheduled Caste / Scheduled Tribe* under :-
* The Constitution (Scheduled Castes) Order, 1950
* The Constitution (Scheduled Tribes) Order, 1950
* The Constitution (Scheduled Castes) (Union Territories) Order, 1951
* The Constitution (Scheduled Tribes) (Union Territories) Order, 1951

[As amended by the Scheduled Castes and Scheduled Tribes Lists (Modification Order) 1956, the Bombay Reorganisation Act, 1960, the Punjab Reorganisation Act, 1966, the State of Himachal Pradesh Act, 1970, the
North-Eastern Areas (Reorganisation) Act, 1971, the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976 and the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 2002]
* 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 Order (Amendment) Act, 1976;
* The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962;
* The Constitution (Dadra and Nagar Haveli) Scheduled Tribes 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 State/Union
Territory*_ _____ who belong to the Caste / Tribe* which is recognised 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 .

Signature:
Designation
Place: (With seal of the Office)
State/Union Territory*

Date:

* Please delete the word(s) which are not applicable.

# Applicable in the case of SC/ST Persons who have migrated from another State/UT.
IMPORTANT NOTES
The term “ordinarily reside(s)**” used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. Officers competent to issue
Caste/Tribe certificates:
1. District Magistrate / Additional District Magistrate / Collector / Deputy Commissioner / Additional Deputy Commissioner / Deputy Collector / Ist Class
Stipendiary Magistrate / City Magistrate / Sub-Divisional Magistrate / Taluka Magistrate / Executive Magistrate / Extra Assistant Commissioner.
2. Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.
3. Revenue Officers not below the rank of Tehsildar.
4. Sub-divisional Officer of the area where the candidate and/ or his family normally reside(s).
5. Administrator / Secretary to Administrator / Development Officer (Lakshadweep Island).
6. Certificate issued by any other Authority will be rejected.

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 Information Bulletin: Common University Entrance Test (UG) - 2023

Annexure-IV
Form-PwD (IV)
Disability Certificate
Certificate for persons with a disability under RPwD Act, 2016 having less than 40% disability

Recent PP size
attested photograph
(showing face only)
of the person with
disability

This is to certify that, we have examined Mr/Ms/Mrs …………. (name of the candidate), S/o /D/o
……………………, a resident of ………………(Vill/PO/PS/District/State), aged …………….. yrs, a
person with ……………………. (nature of disability/condition), and to state that he/she has a limitation
which hampers his/her writing capability owing to his/her above condition. He/she requires the support of a
scribe for writing the examination.
2. The above candidate uses aids and an assistive devices such as prosthetics & orthotics, and hearing aid
(name to be specified) which is /are essential for the candidate to appear at the examination with the
assistance of a scribe.
3. This certificate is issued only for the purpose of appearing in written examinations conducted by
recruitment agencies as well as academic institutions and is valid upto __________ (it is valid for a
maximum period of six months or less as may be certified by the medical authority)

Signature of medical authority

(Signature & Name) (Signature & Name) Signature & (Signature & (Signature &
Name) Name) Name)
Orthopedic / PMR Clinical Psychologist/ Neurologist Occupational Other
specialist Rehabilitation (if available) therapist (if Expert, as
Psychologist/Psychiatrist available) nominated
/ Special Educator by the
Chairperson
(if any)
(Signature & Name)

Chief Medical Officer/Civil Surgeon/Chief District Medical Officer………Chairperson

Name of Government Hospital/Health Care Centre with Seal

Place:
Date:

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 Information Bulletin: Common University Entrance Test (UG) - 2023

Annexure-V
Letter of Undertaking for Using Own Scribe

I __________________________, a candidate with_______________________(name of the disability) appearing

for the ___________________________(name of the examination) bearing Application No.

__________________at_____________________ (name of the centre) in the District __________,

______________________________ (name of the State). My qualification is ___________________________.

I do hereby state that_________________________________(name of the scribe) will provide the service of

scribe/reader/lab assistant for the undersigned for taking the aforesaid examination.

I do hereby undertake that his qualification is _________________________________. In case, subsequently, it is

found that his qualification is not as declared by the undersigned and is beyond my qualification, I shall forfeit

my right to the admission and claims relating thereto.

(Signature of the candidate with disability)

Place:
Date:
Photograph of Scribe

(Self-Attested Photograph)

Name of Scribe ID of the Scribe ID Number

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