Caste Validity Certificate in English

Topics: Education, Certificate authority, Maharashtra Pages: 11 (1379 words) Published: October 22, 2013
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

................................................................... ................................................................... 4
Full Name of applicant's Father and Permanent Address
(If Father is not alive please mention full address of his last Residence.) Village/Town..............................................
Taluka........................................................... District.......................................................... Pin Code.......................................................

5
Full Name of applicant's Grand Father (Father's Father)
---------------------------------------------
6
Present occupation/service of applicant's father with telephone number and address ---------------------------------------------
............................................................ 7
Father's Education
............................................................ 8
Inherited Profession of Family
............................................................ 9
Applicant's (a) Mother Tongue
(b) Regional Dialect
(c) God/Godess
(d) Five Surnames of
applicant's Relative/persons from caste ............................................................. .............................................................. .............................................................. .............................................................. ...............................................................

10
Applicant's (a)Native Place

(b) If applicant has left Native place
Please specify when and who left the place and reason for leaving (c) Since when applicant is residing at
present address.
(d) At present who is residing at native
place
Please give address and Telephone No.
(e) Whether applicant is holding
house, land at native place?...
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