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    Caste Certificate

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    Romin PhyRoy
    Romin P Roy is applying for a caste certificate. He provides his personal details including name, age, address, family details, and contact information. He states that he and his parents are Christian and belong to the Syro-Malabar Catholic caste. He declares that the information provided is true and agrees to be liable for any losses due to incorrect information. The document outlines instructions for correctly filling out the application form.

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    © All Rights Reserved
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    Caste Certificate

    Uploaded by

    Romin PhyRoy
    50 views3 pages
    Romin P Roy is applying for a caste certificate. He provides his personal details including name, age, address, family details, and contact information. He states that he and his parents are Christian and belong to the Syro-Malabar Catholic caste. He declares that the information provided is true and agrees to be liable for any losses due to incorrect information. The document outlines instructions for correctly filling out the application form.

    Original Description:

    Cst

    Original Title

    CASTE CERTIFICATE

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    Romin P Roy is applying for a caste certificate. He provides his personal details including name, age, address, family details, and contact information. He states that he and his parents are Christian and belong to the Syro-Malabar Catholic caste. He declares that the information provided is true and agrees to be liable for any losses due to incorrect information. The document outlines instructions for correctly filling out the application form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    50 views3 pages

    Caste Certificate

    Uploaded by

    Romin PhyRoy
    Romin P Roy is applying for a caste certificate. He provides his personal details including name, age, address, family details, and contact information. He states that he and his parents are Christian and belong to the Syro-Malabar Catholic caste. He declares that the information provided is true and agrees to be liable for any losses due to incorrect information. The document outlines instructions for correctly filling out the application form.

    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    of 3

    Form 1A

    (see rule 3)
    COMMON APPLICATION FORM FOR OBTAINING VARIOUS SERVICES FROM TALUK /
    VILLAGE OFFICE
    Nature of Certificate applied for ……Caste Certificate………………………………...
    Purpose: □ State □ Outside State □ Defense Purpose To be produced before

    …......................... General.........................................................
    Language in which the Certificate is required: □ English □ Malayalam
    Part I (General Details)

    Romin P Roy
    1. Name of person for whom certificate is applied for ………………………………………………...
    Male
    2.Gender (M/F) ……………………………………………......................................................................
    27
    3a. Age: …............. 27/06/1995
    3b. Date of Birth: …............…..............

    Details 4. Present Address 5. Permanent Address


    House No: 53 53
    House Name Palampallil Palampallil
    Street / Place Koovappally Koovappally
    Post Office Koovappally
    Koovappally
    PIN code
    686518 686518
    Village Edakkunnam Edakkunnam
    Taluk Kanjirappally Kanjirappally
    District Kottayam
    Kottayam
    Name of Local Body Parathodu Parathodu
    Type of Local Body □ Grama Panchayat □ Municipality □ Corporation

    Roy Joseph
    6. Name of Father: ………………...…………….6a. Christian
    Religion of Father………………….
    RCSC (syromalabar catholic)
    6b. Caste of Father…………………………………………………………………….
    Christian
    7. Name of Mother:Thresiamma Joseph…. 7a. Religion of Mother…………………
    RCSC (syromalabar catholic)
    7b. Caste of Mother……………….................................................................................
    8. Marital Status: □ Married □ Unmarried □ Widow □ Widower □ Divorced
    9. Name of Spouse: ………………….......................................................................................................
    10. Name of Guardian: .............................................................................................................................
    Two
    11. No. of years residing at the present address: ………………………………………………..............
    8921384638
    12. Phone (Res.): Code ...………… Number: ..................................... 13. Mobile: ..……………….............
    [email protected]
    14.Email: ………………………..........................................................................................
    1526059971
    15. Ration Card No: ………………......................................................................................
    16. Driving License No: ...………………………………………………………………….
    7. Election ID Card No ………………...…………………………………………………...
    18. Passport No: ………………...........................................................................................
    Adhaar :- 630398956234
    19. Unique Identity No (UID), if any: ……………………………………........................

    Part II A (To be filled for Caste/Community/ Conversion/Inter-Caste Marriage Certificate)


    (Items 20d to 20i to be filled if caste / religion has been converted)

    20a. Religion: …………….... 20b. Caste: ………………………


    20c.Category: Gen/SC/ST/OBC …………........................
    20d. Religion before conversion: ........................................................
    20e. Caste before conversion……....................................................
    20f. Name before conversion: …………………...................................
    20g. Certificate No (issued by the religious authority): …………............................................
    20h. Dated…………………… 20i. Religious Authority: ………………………..............................

    Part II B (To be filled for Caste/Identification/Nativity /Residential/Domicile Certificates)


    Enter Place of Birth details as follows:

    State District Taluk Village

    23.Applicant Romin P Roy Kottayam Kanjirappally Edakkunnam

    24.Father Roy Joseph Edakkunnam


    Kottayam Kanjirappally

    25.Mother Thresiamma Joseph Kottayam Kanjirappally Edakkunnam


    DECLARATION

    I do hereby certify that the particulars mentioned above are complete and true to the best of my
    knowledge and belief. I also agree that any loss to Government due to the Incomplete or Incorrect
    information provided above may be recovered from my movable/ immovable assets. I also agree that
    the certificate so issued and any benefits accrued in lieu of that stands nullified on proved mis-
    representation.

    Koovappally
    Place: …................................. Signature: …............................................
    24/05/2013
    Date: ….................................. Romin P Roy
    Name of Applicant: …................................

    Relationship with the person for whom certificate is


    Self
    applied for…..................................................................
    (Relationship to be specified if the above declaration
    is signed by Parent / Guardian / Authorized Representative)

    Instructions for filling the Application


    1.Please enter the application particulars correctly and completely.
    2.The personal details will be stored in the citizen database as part of the e-District project.
    3.Filling up of e-District Registration Number is mandatory for all future correspondence.
    4.In order to avail services quickly, please ensure that the information given is correct and complete.
    5.Filling up of Part – I (General details) is mandatory in all applications.
    6.Fill up only Part – I (General details) for Life Certificate and Destitute Certificate.
    7.For additional information, please refer Kerala Information Technology (Electronic Delivery of
    Service) Rules, 2010.

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