FORMAT FOR SC/ ST CERTIFICATE

A candidate who claims to belong to one of the Scheduled Caste or the Scheduled Tribes should submit in support of
his/ her claim an attested/certified copy of a certificate in the form given below, from the District Officer or the sub-
Divisional Officer or any other officer as indicated below of the District in which his parents (or surviving parent)
ordinarily reside who has been designated by the State Government concerned as competent to issue such a
certificate. If both his parents are dead, the officer signing the certificate should be of the district in which the
candidate himself ordinarily resides otherwise than for the purpose of his own education. Wherever photograph is an
integral part of the certificate, the Commission would accept only attested photocopies of such certificates and not any
other attested or true copy.

(The format of the certificate to be produced by Scheduled Castes and Scheduled Tribes candidates applying
for appointment to posts under Government of India)

This is to certify that Shri/Shrimati/Kumari* __________________________ son/daughter of

___________________________________ of village/town*__________________ in District/Division *_______________________ of
the State/Union Territory* ________ belongs to the Caste/Tribes_______________ which is recognized as a Scheduled
Castes/Scheduled Tribes* under:-

The Constitution (Scheduled Castes) order, 1950 ___________________

The Constitution (Scheduled Tribes) order, 1950 ________________
The Constitution (Scheduled Castes) Union Territories order, 1951 * _______________
The Constitution (Scheduled Tribes) Union Territories Order, 1951*______________
As amended by the Scheduled Castes and Scheduled Tribes Lists(Modification) order, 1956, the Bombay
Reorganization Act, 1960 & the Punjab Reorganization Act, 1966, the State of Himachal Pradesh Act 1970, the North-
Eastern Area(Reorganization) Act, 1971 and the Scheduled Castes and Scheduled Tribes Order(Amendment) Act,
1976. The Constitution (Jammu & Kashmir) Scheduled Castes Order, 1956___________
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended by the Scheduled
Castes and Scheduled Tribes order (Amendment Act), 1976*.
The Constitution (Dadra and Nagar Haveli) Scheduled Castes order 1962.
The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order 1962@. The Constitution (Pondicherry)
Scheduled Castes Order 1964@ The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1967 @
The Constitution (Goa, Daman & Diu) Scheduled Castes Order, 1968@
The Constitution (Goa, Daman & Diu) Scheduled Tribes Order 1968 @
The Constitution (Nagaland) Scheduled Tribes Order, 1970 @
The Constitution (Sikkim) Scheduled Castes Order 1978@
The Constitution (Sikkim) Scheduled Tribes Order 1978@
The Constitution (Jammu & Kashmir) Scheduled Tribes Order 1989@
The Constitution (SC) orders (Amendment) Act, 1990@
The Constitution (ST) orders (Amendment) Ordinance 1991@
The Constitution (ST) orders (Second Amendment) Act, 1991@
The Constitution (ST) orders (Amendment) Ordinance 1996@
The Scheduled Caste and Scheduled Tribe Orders (Amendment ) Act 2002@ 58
The Constitution (Scheduled Caste) Orders(Amendment) Act 2002@
The Constitution(Scheduled Caste and Scheduled Tribe) Orders (Amendment) Act 2002@
The Constitution (Scheduled Caste) Order (Amendment) Act 2007@ %2. Applicable in the case of Scheduled
Castes, Scheduled Tribes persons who have migrated from one State/Union Territory Administration.

This certificate is issued on the basis of the Scheduled Castes/ Scheduled Tribes certificate issued to
Shri/Shrimati __________________________Father/mother of Shri/Shrimati/Kumari*___________________________of
village/town*______________________ in District/Division* ______________________of the State/Union
Territory*______________________________ who belong to the _________________________________ Caste/Tribe which is
recognized as a Scheduled Caste/Scheduled Tribe in the State/Union Territory* issued by
the___________________________________dated____________________________. %3. Shri/Shrimati/Kumari and /or *
his/her family ordinarily reside(s) in village/town*________________________________________ of ________________
District/Division* _________________of the State/Union Territory of ____________________________

Signature__________________________

** Designation________________________

(with seal of office)

Place______________

Date_______________
 * Please delete the words which are 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, 1950.

** List of authorities empowered to issue Caste/Tribe Certificates:

(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy

Commissioner/[Link]/Ist Class Stipendiary Magistrate/Sub-Divisional Magistrate/Extra-
Assistant Commissioner/Taluka Magistrate/Executive Magistrate.

(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.

(i) Revenue Officers not below the rank of Tehsildar.

(ii) Sub-Divisional Officers of the area where the candidate and/or his family normally resides.

NOTE: ST candidates belonging to Tamil Nadu State should submit caste certificate ONLY FROM THE REVENUE
DIVISIONAL OFFICER.
 (FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD
CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE
GOVERNMENT OF INDIA)

This is to certify that Shri/Smt./Kumari son/daughter of

of village/town

in District/Division in the State/Union Territory

belongs to the Community

which is recognized as a backward class under the Government of India, Ministry of Social
Justice and

Empowerment’s Resolution No. dated *.

Shri/Smt./Kumari and/or his/her family ordinarily reside(s) in the

District/Division of the
State/Union Territory. This is also to certify that he/she does not
belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the
Government of India, Department of Personnel & Training O.M. No. 36012/22/93-Estt (SCT)
dated 8.9.1993**.

District Magistrate:

Deputy Commissioner etc.:

Dated:

Seal:

* The authority issuing the certificate may have to mention the details of Resolution of
Governmentof India, in which the caste of the candidate is mentioned as OBC.

** As amended from time to time.

Note: The term ”Ordinarily” used here will have the same meaning as in Section 20 of the
Representation of the People Act,1950.
 Government of ...............

(Name & Address of the authority issuing the certificate)

INCOME & ASSEST CERTIFICATE TO BE PRODUCED BY ECONOMICALLY

WEAKER SECTIONS

Certificate No. Date

VALID FOR THE YEAR

This is to certify that Shri/Smt./Kumari son/daughter/wife of

permanent resident of ,
Village/Street PostOffice District in the
State/ Union Territory Pin Code whose photograph is attested below
belongs to Economically Weaker Sections, since the gross annual income* of his/ her ‘family’** is below Rs. 8
Lakh (Rupees Eight Lakh only) for the financial year His/ her family does not own or possess any of the
following assets *** :

I. 5 acres of agricultural land and above;

II. Residential flat of 1000 sq. ft. and above;

III Residential plot of 100 sq. yards and above in notified municipalities;

IV Residential plot of 200 sq. yards and above in areas other than the notified
municipalities.

2. Shri/Smt./Kumari belongs to the

castewhich is not recognized as a Scheduled Caste, Scheduled Tribe and Other Backward Classes
(Central List).

Signature with seal of Office

Name

Designation

Recent Passport size

attested photograph of the
applicant

*Note 1: Income covered all sources i.e. salary, agriculture, business, profession etc.

**Note 2: The term ‘Family’ for this purpose include the person, who seeks benefit of
reservation, his/ her parents and siblings below the age of 18 years as also
his/herspouse and children below the age of 18 years.
***Note 3: The property held by a “Family” in different locations or different places/cities have been
clubbed while applying the land or property holding test todetermine EWS status.
 Certificate for serving Defence Personnel

I hereby certify that, according to the information available with me (No.)

__________________________________ (Rank) ___________________ (Name) ___________________________ is due to
complete the specified term of his engagement with the Armed Forces on the (Date) ____________________.

(Signature of Commanding Officer)

Office Seal

Place:

Date:
 UNDERTAKING TO BE GIVEN BY THE EX-SERVICEMEN

I ……………………………., bearing Roll No… ............................................. ,appearing for the

Document Verification of the ..................................................................... Examination,
20… .......... , do hereby undertake that:

(a) I am entitled to the benefits admissible to Ex-Servicemen in terms of the Ex- Servicemen
Re-employment in Central Civil Services and Posts Rules, 1979, asamended from time to
time.

(b) I have not joined the Government job on civil side (including Public Sector Undertakings,
Autonomous Bodies/ Statutory Bodies, Nationalized Banks, etc.) in Group ‘C’ and ‘D’
posts on regular basis after availing of the benefits of reservation given to ex-serviceman
for re-employment; or

(c) I have availed the benefit of reservation as ex-serviceman for securing Government job
on civil side. I have joined as …………………………….on…
in the
office of ………………………………………………………… I hereby undertake that I have
submitted the self-declaration/ undertaking to my current employer about date wise
detail of the application for the above mentioned examination for which I had applied for
before joining the present civil employment; or

(d) I have availed the benefit of reservation as ex-serviceman for securing Government job
on civil side. I have joined as …………………………….on…
in the
office of ……………………………………. Therefore, I am eligible for age- relaxation only;
I hereby declare that the above statements are true, complete and correct to the best of
my knowledge and belief. I understand that in the event of any information being found
false or incorrect at any stage, my candidature/ appointment is liable to be cancelled/
terminated.

Signature: .....................
Name: …………….
Roll Number: ....................
Date: …………….
Date of appointment in Armed Forces: …………….
Date of Discharge: …………….
Last Unit/ Corps: …………….
Mobile Number: …………….
Email ID: …………….
 ICFRE and Govt. Employee Certificate

Certificate to be furnished by the Employer/Forwarding Authority

Certified that:

(i) The particulars furnished by Shri/Smt………………………….....are correct.

(ii) There is no vigilance/disciplinary case either pending or contemplated against him/her.

(iii) Integrity of the applicant is certified.

(iv) Photocopies of the up-to-date ACRs, attested by an officer not below the Rank of an Under
Secretary to the Government of India are enclosed.

Date:

(Signature of Head of the Department/Forwarding Authority)

Name………………………………

Department………………………

Office……………………………….

Tel. No……………………………..

Fax No……………………………..

Mobile………………………………