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SC Application Form For SC

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Application form for SC/ST/OBC Certificate

1. Application to : State....., Dist...


Sub- Division (S.D.O): .
Block/Municipality : ..

Attach
applicants
resent
passport size

photograph.

2. Applying for : (SC/ST/OBC): . Caste/Tribe/Community:..

3. Name:
4. Father Name: .
5. Mobile No.... Email ID:

7. Date of Birth:..
Place of Birth : State : ...., Dist : ....
Police Station : .. Vill/City : ..
8. Address: Present Address for last 6 months:
C/O (Name)- ..., State : ...
District : ...., Police Station : ..
Ward/GP (Gram Panchayats) :
Vill/Para/House No./Road : ...
Post Office : . PIN No : ...
Permanent Address: Same as present Yes/No. If No
9.

Nationality : ...................... 10. Religion: ... 11. Gender : ...

..

12. Blood relation (paternal side) details: Certificate Holders Name:


..

Relation with applicant : ........., Certificate No : .


Date of Issue : ........................................., Issueing Authority : ....
13. Details of two local referees :
a). Name of referee-1:
b) Address of Referee-2 : ...............................................................................................
Pin.

a) Name of referee-1: ..
b) Address of Referee-2 : ...............................................................................................
Pin.

Only For OBC : Name of Fathers Organisation:.., Mothers .


Agriculture Land holding : Location: ..Size of Holding : ...Agri Land.
Annual Income from salary/other resources: Rs.-..

Birth Certificate : Reg. no. ., No: ...., Issuing Date : ..


Applicant Voter ID No: ............., Reson Card no-.......Date....
Admit Card no- ., PAN-.., Passport no-
Father/Mother Voter ID No:...,Part no-Serial no: ..

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