Domicile Certificate

Competent authority to issue domicile certificate
a) Proforma ‘a1’ or ‘b’ must be signed and certified by any of the following
competent authorities from Central Government or State Government having
local jurisdiction over the place of the permanent residence of the concerned
candidate or his/her parents viz.
i. District Magistrate, Additional District Magistrate, Deputy Magistrate,
Deputy Collector, Sub – Divisional Officer, Block Development Officer.
ii. Superintendent of Police, Additional Superintendent of Police, Sub
Divisional Police Officer, Deputy Superintendent of Police,
iii. Commissioner, Additional Commissioner, Joint Commissioner, Deputy
Commissioner, Assistant Commissioner of Police Commissionerate.
iv. Judicial Magistrate of any rank or position in the concerned district or
Metropolitan locality or Hon’ble High Court at Calcutta or Hon’ble Supreme
Court of India.
v. Corporation Area - Commissioner, Additional Commissioner, Joint
Commissioner, Assistant Commissioner.
vi. Assistant Secretary or above in the Secretariat to the Government of West
Bengal (including GTA) or Central Government.
vii. Deputy Director or above in the Directorate to the Government of West
Bengal or Central Government.
b) Officials issuing domicile certificates MUST provide his/her full name,
designation, place of posting with address, land line/mobile number. He/she
should also provide his/her identity card number if available.
c) Note: Domicile certificates issued by any elected people’s representative such as
municipal commissioner, Councillor of Municipal Corporation/ Municipality,
Member of three-tier Panchayat system or GTA, MLA or MP are not acceptable.
d) Proforma ‘a2’ must be signed and certified by the Head of the Institution from
which the candidate has passed or will appear in 10+2 examination. Such
certificate must be issued after verification of the school education record of the
candidate.
PROFORMA a1
Residential/Domicile Certificate for candidates residing in the State of West Bengal

continuously for at least last ten (10) years as on 31.12.2021.
Certified that
Son / daughter of is a resident/permanent

resident of West Bengal at Village/House No.
Street
Post Office Police Station
In the District of under

Assembly Constituency and has been living in the State of West Bengal continuously /
uninterruptedly at least for the last ten (10) years as on 31-12-2021.
Paste 4 cmx3 cm Candidate’s signature

size recent colour
photograph in this
box
Candidate must sign here in front of the certifying
authority
(Candidate’s photograph)
Signature of Certifying Authority

Designation with Official Seal
Full Name of Certifying Authority
Office Address
Office Phone No. Mobile No: (optional)
ID No: (optional)
Note: Photograph is to be attested by the certifying authority.

The Certifying Authority should preserve a duplicate copy of this Certificate.
PROFORMA a2
Residential/Domicile Certificate for candidates residing in the State of West Bengal
continuously for at least last ten (10) years as on 31.12.2021.
Certified that son / daughter of

has passed the ‘10+2’ Examination in the
year / will appear in the Final ‘10+2’ Examination in 2022 from this Institution.
It is also certified that the student is a resident/permanent resident of West Bengal at
Village/House No.
Street Post Office
Police Station in the district of
under Assembly Constituency and has been living and

studying in the State of West Bengal continuously / uninterruptedly at least for the last
ten (10) years as on 31-12-2021.
Candidate’s signature
Paste 4 cmx3 cm Candidate must sign here in front of the certifying

size recent colour authority
photograph in this
box
(Candidate’s photograph)
Office Address
ID No: (optional)
Note: Photograph is to be attested by the certifying authority.

PROFORMA b
Residential/Domicile Certificate for candidates not residing in the State of West Bengal
but whose parent(s) is (are) permanent resident(s) of West Bengal having their permanent
home address within West Bengal.
Certified that
Father/ mother of (the applicant) is/ are

permanent Resident of West Bengal at Village/House No.
Street
Post Office Police Station
In the District of
Under Assembly Constituency
Father’s/ Mother’s Signature

Paste 4 cmx3 cm
Paste 4 cmx3 cm
size recent colour
size recent colour
photograph of
photograph of the
father/ mother of Candidate’s Signature
candidate in this
the candidate in
box
this box
Candidate must sign here in front of
the certifying authority
(Candidate’s Photograph) (Father’s/ Mother’s Photograph)
Office Address
ID No: (optional)
Note: Photographs are to be attested by the certifying authority.


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Competent authority to issue domicile certificate

Residential/Domicile Certificate for candidates residing in the State of West Bengal

Son / daughter of is a resident/permanent

Post Office Police Station

In the District of under

Paste 4 cmx3 cm Candidate’s signature

Signature of Certifying Authority

Full Name of Certifying Authority

Office Phone No. Mobile No: (optional)

Note: Photograph is to be attested by the certifying authority.

Certified that son / daughter of

Police Station in the district of

under Assembly Constituency and has been living and

Paste 4 cmx3 cm Candidate must sign here in front of the certifying

Signature of Certifying Authority

Designation with Official Seal

Full Name of Certifying Authority

Office Phone No. Mobile No: (optional)

Note: Photograph is to be attested by the certifying authority.

Father/ mother of (the applicant) is/ are

Post Office Police Station

Under Assembly Constituency

Father’s/ Mother’s Signature

Signature of Certifying Authority

Designation with Official Seal

Full Name of Certifying Authority

Office Phone No. Mobile No: (optional)

Note: Photographs are to be attested by the certifying authority.

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