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12 862 2070 5 6 0 0 3 5 8 279 1

Form B-2 (Amended)


RULE 5(5)(4)(V)
Form of Caste Certificate to be issuedOther Backward Classes, Vimukta Jati (A) Nomadic
Tribes (B,C&D), Special Backward Class, Educationally and Socially Backward Class and
Special Backward Class (A) and its synonyms belong to State of Maharashtra
Documents Verifled
1 Income
2 of Ration Card
Sebool Leaving Certificate
4 Residence Proof By Talathi
5 Self Declaration
6 Aadhar Card
Cast Certificate Benificiary
8 Domacial
9 Cast Certificate Benificiary
10 Domacial
11 Benificiary LC
12 Aadhar Card Benificiary

SDO/Non Creamy OBC Reg./Case No Year: 2023- 2024


Outward No: 41796063015 Dated: 05/06/2023

CASTE CERTIFICATE (PART-A)


This is to certifythat Kumari Sayali Nitesh Modak Daughter of Shri Nitesh Laxman Modak
of village Kanti, taluka Roha, district Raigarh of the State of Maharashtra belongs to the Kunbi ( 83
) castewhich is recognized as Other Backward Classunder the Government Resolution No CBC
1467/M dated 13/10/1967 as amended from time to time.
Kumari Sayali Nitesh Modak andlor his family ordinarily reside(s) in village Kanti, taluka
Roha, district Raigarh of the State of Maharashtra.
NON-CREAMY LAYER CERTIFICATE (PART-B)
This is to certify Kumari Sayali Nitesh Modak does not belong to the persons/sections
(Creamy-layer) mentioned in the a cnt of Maharashtra Gazette, Part IV-B, dated 29th
January 2004, Maharashu a State Public Service Commission (Reservation for S.C./S.T./D.T.
(V.J.JN.T.,S.B.C. &O.B.C. Act, 2001 and instructions and guidelines laid down in the Government
Resolution,Social Justice, Cultural Affairs, Sports and Special Assistance Department No. CBC
10/2001/Pra.Kra,120/Mavak-5, dated 1st November 2001, CBC-1094/Pra.Kra.86/Mavak-5, dated
16th June, 1994, CBC-1094/Pra.Kra.86/Mavak-5, dated 5th June, 1997 and Government
Resolution No.CBC- 10/2001/Pra.Kra.111/Mavak-5, dated 29th May 2003 and Government
Resolution No. VJNT-2014/C.R.118NJNT-1, dated 31st July 2014
This Certificate is valid for the period upto 31-Mar- 2026 from the date of issue.

Signature valid
Digitally Sigjed by
Vitthalnafdar
Date:2023-08-28.1:25:30 PM
Suu uIVIDIUIa Officer
Place : Roha
Date : 28/08/I2023 (With the seal of Office) Roha

Printed By-OMTID:MHO13400815 VLEName :Sandeep Sawant, Date:28/08/2023 1:06PM


This is adigitally signed document, hence is legally valid as per the Information Technology (T) Act, 2000.
To verify visit https://www.mahaonline.gov.inVerify OR SMS MH<Space>CSC<space>VRFY<20 digit Bacode numberr" to 166 from a BSNL, MTNL, Tata Mobile and
51965 from others.

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