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(Rule 14) : FORM-19

1. This is an affidavit form for government or semi-government employees to submit with an application for caste certificate verification. 2. The applicant declares that the caste certificate submitted for scrutiny was issued by the appropriate authority and is true and correct. 3. The applicant affirms that the documents submitted are not duplicate, bogus, or previously invalidated by a scrutiny committee.

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Ashish Telmasare
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753 views1 page

(Rule 14) : FORM-19

1. This is an affidavit form for government or semi-government employees to submit with an application for caste certificate verification. 2. The applicant declares that the caste certificate submitted for scrutiny was issued by the appropriate authority and is true and correct. 3. The applicant affirms that the documents submitted are not duplicate, bogus, or previously invalidated by a scrutiny committee.

Uploaded by

Ashish Telmasare
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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FORM-19

[rule 14]
For Government / Semi Government Employee
Affidavit to be submitted with application Caste Certificate Verification

I, Shri/Smt./ …....................................................................................................................................
age……………………………………… years, Occupation ………………………....................................
residing at…………………………………………………………………………………………………...
hereby solemnly affirm today dated ............................................................................. that caste certificate
of my son/ daughter Number .................................................. dated .............................................. given by
Tahasildar and Executive Magistrate / Deputy Collector / Sub Divisional Officer………………... District is
submitted for the Scrutiny.
Validity Certificate is required for my Appointment / Promotion in reserve category.
The documents and proofs attached with the application Form are obtained by me from Competent
Authority. These documents are true and correct and obtained by following proper procedure. No alteration
/ correction / change are made in these documents. I affirm hereby that these documents are not duplicate or
bogus.
*Caste Certificate of any relative from my paternal side was not invalidate by the Scrutiny Committee.
*And it is not a case that I applied before any Caste Certificate Scrutiny Committee in Maharashtra
and my caste certificate is invalidated.
I will be responsible, if the documents and proofs attached with the application form are found to
be incorrect or bogus, and I am aware that I will be liable for punishment under provision of Indian Penal
Code.
I declare that the above mention information is true and correct, hence this affidavit.

Place:
Date:

(*Delete which is not applicable)

---------------------------------
Signature of the Declarant

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