Certificate for Other Backward Classes

THE FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES

CANDIDATES APPLYING FOR APPOINTMENT TO POSTS AND FOR ADMISSION IN
EDUCATIONAL INSTITUTES UNDER GOVERNMENT OF INDIA
This is to Certify that Shri/Shrimati/Kumari*.
Son/daughter* of Shri..of Village/Town*
....in District/Division*..of
the State/Union Territory*...elongs
to the.Community which is recogni!ed as a ac"ward class under #$
% &overnment of 'ndia( )inistry of *elfare +esolution ,o. -./--/01/2345CC 6C7 dated -/
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% &overnment of 'ndia( )inistry of Social @ustice and 9m8owerment +esolution ,o. -./--/</.//.4
5CC dated -3
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@anuary( .//< 8ulished in the &a!ette of 'ndia 9:traordinary ;art4'( Section4-( ,o.
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Shri/Shrimati/Kumari*........and/or*
his/her* family ordinarily resided in Village/Town.....of
District/Division* of the State/Union Territory* of.
This is also to certify that he/she* does not elong to the 8erson/sections* 6Creamy layer7 mentioned in
column 3 of the Schedule to the &overnment of 'ndia( De8artment of ;ersonnel B Training =.). ,o.
30/-./../2349stt. 6SCT7 dated /1
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Se8temer -223( =.). ,o. 30/33/3/.//<49stt 6+es.7 dated /2
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;lace# Signature
Date **Designation
6*ith Seal of =ffice7
*8lease delete the words which are not a88lication.
%Stri"e out *hichever is not a88licale.
Note : The term C=rdinarily reside6s7D used here will have the same meaning as in Section ./ of the
+e8resentation of the ;eo8le Act( -2?/.
**Eist of authorities em8owered to issue =5C Certificate.
6i7 District )agistrate/Additional District )agistrate/Collector/De8uty Commissioner/Additional
De8uty Commissioner/De8uty Collector/-
st
Class Sti8endiary )agistrate/FSu4Divisional
)agistrate/Talu"a )agistrate/9:ecutive )agistrate/9:tra Assistant Commissioner.
6Fnot elow of the ran" of -
st
Class Sti8endiary )agistrate7
6ii7 Chief ;residency )agistrate/Additional Chief ;residency )agistrate/;residency )agistrate.
6iii7 +evenue =fficers not elow the ran" of Tehsildar.
6iv7 Su Divisional =fficer of the Area *here the candidate and/or his/her family normally resides.
6v7 Administrator/Secretary to Administrator/Develo8ment officer 6Ea"shadwee87.
Note 1: Candidates claiming to elong to =5Cs should note that the name of their caste 6including its
s8ellings7 as indicated in their certificates( should e e:actly the same as 8ulished in the lists
notified y the Central &overnment from time to time. A certificate containing any variation in
the caste name will not e acce8ted.
Note 2: The =5C claim of a candidate will e determined in relation to the State 6or 8art of the State7
to which his/her father originally elongs. A candidate who has migrated from one State 6or
8art of the State7 to another should( therefore( 8roduce an =5C certificate which should have
een issued to him/her ased on his/her fatherGs =5C certificate from the State to which he
6father7 originally elongs.
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Form o !e"#$r$t%o& to 'e ()'m%tte! '* t+e OBC "$&!%!$te ,%& $!!%t%o&
to t+e "omm)&%t* "ert%%"$te-
'. Son/Daughter of
Shri.resident of Village/Town/City
District.State....
..herey declare that ' elong to
the..community which is recogni!ed as a ac"ward class
y the &overnment of 'ndia for the 8ur8ose of reservation in services as 8er orders contained in
De8artment of ;ersonnel and Training =ffice )emorandum ,o. 30-/./../2349stt. 6SCT7 dated /1
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Per(o&&e# 4 Tr$%&%&. O5M5 No5 167120220819E(tt5 ,SCT- !$te! 7:
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Se/tem'er 18813 O5M5 No5
16711010277;9E(tt5 ,Re(5- !$te! 78
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Signature#
Hull ,ame#..
Date#...
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Address 6=rdinary +esidence7
UNDERTAKING BY OBC (NCL) - MINORITY CATEGORY CANDIDATES
I, __________________________________ son / daughter of Shri
___________________________ resident of village/town/city
________________________ district ___________________________ State
_______________ hereby declare that I belong to OBC (NC! " #INO$I%& Category as
notified by Central 'overn(ent of India) I also declare that the condition of status / annual
inco(e for *Crea(y ayer+ of (y ,arents is within ,rescribed li(its as on financial year
ending on #arch -., /0./)
Signature12222222222222
3ull Na(e12))22222222222
4ate122)2))22222222222
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