FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE
BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE
509/3023
IN SUPPORT OF HIS CLAIM
FORM OF CASTE CERTIFICATE
This is to certify that Shri/Shrimati/Kumari D(AMTLARAHUL
Son/Daughter of_RAHBAR) of village town UlUGuA in
district/ division
SRIVALULAM belongs to theSC- mA LA
Caste/Tribe which is recognized as a Scheduled
Caste/Scheduled Tribe
Under:
The Constitution (Scheduled Castes) order, 1950
The Constitution (Scheduled Tribes) RAVERUWANDÁL
order, 1950
The Constitution (Scheduled Castes) (Union Territories) Order 1951 SRIKAKULAM DIS :
(asamended by the Scheduled Castes and Scheduled Tribes
the Bombay Lists (Modification) order 1956
Reorganisation Act, 1960, the Punjab
Himachal Pradesh Act 1970, the north eastern Reorganisation Act 1966, the State of
Scheduled Castes and Schedules areas(Reorganisation)
Tribes Order (Amendment) Act 1976).
Act 1971 and the
The Constitution (Jammu&
The Constitution (AndamanKashmir) Scheduled Caste Order, 1956
by the Scheduled Castes and& Nocobar Islands) Scheduled Castes Order, 1959 as
Scheduled Tribes Order (Amendment) Act, 1976.
The Constitution (Dadra & Nagar amended
The Constitution Havelli) Scheduled Castes Order 1962.
The Constitution (Pondicherry) Scheduled Castes Crder 1964.
(Scheduled Tribes) (Uttar Pradesh) Order 1967
The Constitution (Goa,
The Constitution Daman & Diu) Scheduled Ca stes, Order
(Nagaland)
The Constitution (Sikkim) Scheduled Tribes Order, 1970 1968
The Constitution (Sikki) Scheduled Castes Order 1978
Scheduled Tribes Order 1978
Applicable in the case of Scheduled
from one State/Union Territory Castes/Scheduled Tribes persons who have migrated
Administration
!
This certificate is issued on the basis of the Scheduled Caste lScheduled Tribe Certificates issued to
Shri/Shrimati+ DLCANTLA RAHUL Father/mother of Shri/Shrimati/Kumari*
RAHRAR) of villag/town URANCaURILLIAR in District /
Division SRKAKULAM of the State/Union Territory*
ANDHÂAPRADESH who belong to the
HALA Caste/Tribe* whiçh is reçognized gs Scheduled Caste
Ardhaa
| Scheduled Tribe* in the State / Union Territory* CeetLO9REissued by the
(Name of prescribed authority) vide their Order No.
dated
Shri/ShrimatKumari"_uDIaATA RAHUL and/or
"hisher family ordinarily reside(s) in village / town* GueuGUBILL_of
SAIKAkULAM District/Division* of the State/Union Territory* of
ANDHRA PRADEES
A
LAV
Hy
Srikakuiamn Ois. $ignaturgALTHAR
Place
(Withsééf offiçep:
State/UnoReAt
SesignaevERUMANOAt
SRIKAKULAM DiST.
Date
*Please delete whatever is not applicable
@Please quote specific presidential order
$ Delete the paragraph which is not applicable
NOTE: The term "Ordinarily reside (s)* used here will have the same meaning as in Section 20 of the
Representation of the People Act, 1960.
*List of authorities empowered to issue Scheduled Caste / Scheduled Tribe Certificate:
1. District Magistrate /Additional District Magistrate /Collector/Deputy Commissioner / Additional
Deputy Commissioner / Deputy Collector / 1 Class Stipendary Magistrate / City
Magistrate /Taluka Magistrate Executive Magistrate /Extra Assistant Commissioner
*(Note below the rank of 1st Class Stipendary magistrate)
2 Chief Presidency Magistrate /Additional Chief Presidency Magistrate
3 Revenue Officers not below the rank of Tehsildar /Presidency Mlagistrate
4 Sub-Divisional Officer of the area where the candidate and/or his family normally resides
Administrator/Secretary to Administrator/Development Officer (Lakshadweep Islands)
