Caste Validity Certificate in English

FORM-15
(Rule No.14)

FOR STUDENTS

EDUCATION EDUCATION

Application Form for verification of Scheduled Caste/Scheduled Caste convert to Buddhism/De -Notified Tribe (Vimukta Jati)/ Nomadic Tribe/Other Backward Class/Special Backward Category certificate to be submitted to Divisional Caste Certificate Scrutiny Committee.

To, Member Seceretary and Research Officer, Divisional Caste Scrutiny Committee, No......... ............................................

Sub :- Verification of Scheduled Caste/Scheduled Caste converts to Buddhism/De- Notified Tribe (Vimukta Jati)/ NomadicTribe/Other Backward Class/Special Backward Category Caste certificate (Strike out whichever is not applicable)
Sir,
I, the undersigned Shri/Smt/Kum........................................................hereby request to verify my caste certificate of Scheduled Caste/Scheduled Caste converts to Buddhism/De-Notified Tribe (Vimukta Jati)/Nomadic Tribe/Other Backward Class/Special Backward Category. Following information and documents are submitted herewith in support of my caste claim.

1
(a) Full name of the Applicant (as mentioned in caste certificate)and present address
.........................................................................
.........................................................................
..................................Pin Code........................

(b) Mobile No.
..........................................................................

(c) E-Mail
...........................................................................M
2
Caste/Sub Caste claimed by applicant
...........................................................................
3
Applicant's a) Birth date b) Birth place