FORMAT OF CASTE CERTIFICATE TO BE SUBMITTED BY SC/ST APPLICANTS Form of Certificate as prescribed in M.H.A., OM.No.42/21/49‐N.G.S., dated 28.01.1952 as revised in Dept. of Per. & A.R., Letter No.36012/6/76‐Estt.(S.C.T.) dated 29.10.1977, to be produced by a candidate belonging to a Scheduled Caste or Scheduled Tribe in support of the claim. FORM OF CASTE CERTIFICATE This is to certify that Shri/Shrimathi/Kumari* _________________________________________________ son / daughter* of Shri Village / Town* _______________________________________________________ of ______________________________ in District / Division* _______________________ of the State / Union Territory* of __________________________ belongs to the ___________________ Caste / Tribe* which is recognised as a 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 & 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 and the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976.] *The Constitution (Jammu & Kashmir) Scheduled Castes Order, 1956 *The Constitution (Andaman & Nicobar Islands) Scheduled Tribes Order, 1959, as amended by the Scheduled Castes & Scheduled Tribes Orders (Amendment Act, 1976) *The Constitution (Dadra & Nagar Haveli) Scheduled Castes Order, 1962 *The Constitution (Dadra & 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 & Diu) Scheduled Castes Order, 1968 *The Constitution (Goa, Daman & Diu) Scheduled Tribes Order, 1968 *The Constitution (Nagaland) Scheduled Tribes Order, 1970 *The Constitution (Sikkim) Scheduled Castes Order, 1978 *The Constitution (Sikkim) Scheduled Castes Tribes, 1978 *The Constitution (Jammu & Kashmir) Scheduled Tribes Order, 1989 *The Constitution (Scheduled Castes) Orders (Amendment) Act, 1990 *The Constitution (Scheduled Tribes) Order (Amendment) Act, 1991 *The Constitution (Scheduled Tribes) Order Second Amendment Act, 1991 2. Applicable in the case of Scheduled Castes/Scheduled Tribes persons who have migrated from the State/Union Territory Administration. This Certificate is issued on the basis of the Scheduled Castes / Scheduled Tribes Certificate issued to Shri / Shrimathi* ________________________________, father/ mother* of Shri / Shrimathi / Kumari* ________________________________ of Village / Town* _______________________ in District / Division* _______________________ of the State / Union Territory* of __________________________ who belong to the Caste / Tribe* which is recognised as a Scheduled Caster / Scheduled Tribe* in the State / Union Territory of _______________________ issued by the _________________ , dated __________________. 3. Shri / Shrimati / Kumari* _______________________ and / or* his / her* family ordinarily reside(s) in Village / Town* _______________________ of the State / Union Territory* of _____________________________. SEAL OF OFFICE Signature: ___________________________ Designation: ___________________________ PLACE: __________________ STATE / UNION TERRITORY: _____________ DATE : __________________ NOTE. ‐ The term "Ordinarily resides" used here will have the same meaning as in Section 20 of the Representation of the Peoples Act, 1950. * Please delete the words which are not applicable. The authorities competent to issue caste certificate are indicated below:­ (i) District Magistrate / Additional Magistrate / Collector / Deputy Commissioner / Additional Deputy Commissioner / Deputy Collector / Fist Class Stipendiary Magistrate / Sub‐Divisional Magistrate / Taluka Magistrate / Executive Magistrate / Extra Assistant Commissioner (not below the rank of First Class Stipendiary Magistrate). (ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate. (iii) Revenue Officer not below the rank of Tahsildar; and (iv) Sub‐Divisional Officer of the area where the candidate &/or his family resides.