AFFI DAV IT

(FOR SC/ST CASTE CERTIFICATE)

BEFORE THE LD. MAGISTRATE, AT

I SMT. SABITA MONDAL, bearing AADHAAR Card No.

3866 4628 0660, Wife of Sri Rabi Mondal alias Rabin
Mondal, aged about 34 years, by faith Hindu, by
Occupation : Domestic Lady residing at: - Mahendranagar,
P.O. Natagarh, P.S. Ghola, Dist. North 24 Parganas, PIN –
700113, do hereby solemnly affirm and declare as follows :
1. That I am the bonafide Citizen of India and residing
at the above noted address with my other family members;
2. That my son SRI RIPAN MONDAL, bearing
AADHAAR Card No. 4329 9200 0082 have a Birth
Certificate Vide Registration No. 542, dated 15/04/2004, in
Form No. 5, Serial No. 72097, duly issued by Department
of Health & Family Welfare Govt. of West Bengal, at the 2
No. Bethuadahari, Nakashipara, District Nadia thereby his
Date of Birth is depicted as 13/04/2004; Contd……….2
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3. That my ancestors as well as the ancestors of my in-laws, told
me that they altogether belong to the ‘NAMASUDRA’ Cast, by birth,
which is recognized as a Scheduled Caste/Scheduled Tribe under
Constitution (Scheduled Castes) Order 1950 and the Constitution
(Scheduled Tribes) Order 1950, as amended by the Scheduled Castes
and Scheduled Tribes Lists (Modification) Order, 1956;

4. That in the above stated address I, SMT. SABITA MONDAL,

bearing AADHAAR Card No. 3866 4628 0660, Wife of Sri Rabi Mondal
alias Rabin Mondal, under the same caste stated above has been
residing for GENERATIONS i.e. a long time (above 50 years) and we
have not got any Schedule Certificate so far, save and except my
Cousin Sri Prasenjit Mondal, bearing AADHAAR Card No. 6926 2915
2347, son of Sri Ranjit Mondal, of Indira Nagar, P.O.
Purnanandapalyi, P.S. Naihati, District North 24 Parganas, PIN
743165, who already has been possessing the Schedule Caste
Certificate being No. A88438/SC/ST/BKP, dated 14/06/2012;

That purpose of this affidavit is to duly procure a Schedule Caste

Certificate, from the competent authority, through a proper
investigation.

That the above statements of this Affidavit are true to the best of my
knowledge and belief and rests are on Record.

Solemnly affirmed before me
by the declarant who is Identified
by Sri Shankar Nath Chakraborty
Advocate,on _____________
Declarant
Contents read over and explained
to the declarant who admitted it to
be correct and identified by me
and signed in my presence

Magistrate, Calcutta, Advocate.