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FORM "C"
[See Rule 4(6) and 5(2) (a) and (b)]
Form of Scheduled Tribe Certficate
(For Ordinary residents of Maharashtra)
Outward No : 395911398882 Application Date : 25/02/2025
Rev Case No : MRC : 395911398882
This is to certify that Shri/Shrimati/Kumari Mirabai Bhivsan Thakare Daughter of
Shri/Shrimati Bhivsan Nagu Thakare of Village/Town Ner taluka Dhule, in District/Division Dhule
of the State belongs to the Bhil tribe [Link]. 8 which is recognized as a Scheduled Tribe under:
#The Constitution (Scheduled Tribes) Order, 1950
[As amended by The Scheduled Castes/ Scheduled Tribes Lists (Modification) Order, 1956, The
Bombay Reorganisation Act, 1960]
#The Constitution Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976
(No.108 of 1976).
#The Constitution Scheduled Castes and Scheduled Tribes Order(Amendment) Act, 2002 (No.10 of
2003).
2. Shri/Shrimati/Kumari Mirabai Bhivsan Thakare and/or her family ordinarily reside(s) in
Village/Town Ner taluka Dhule, of Dhule District/Division of the State of Maharashtra.
Applicable to the
Migrants within (Applicable in the case of Scheduled Tribes persons who have migrated from one District to another
the Maharashtra District within the Maharashtra State.)
State.
3. This certificate is issued on the basis of the Scheduled Tribe Certificate issued to
Shri/Shrimati ___________ ___________ of Shri/Shrimati/Kumari ___________ of Village/Town
___________ taluka ___________ in District/Division ___________ of ___________ who belongs
to the ___________ Tribe which is recognized as a ___________ in the ___________
___________ issued by the ___________ vide their No. ___________ dated ___________
Digitally Signed by
Rohan Raghunath Kuwar
Date:27-02-2025 19:28:17
Place : Dhule Sub Divisional Officer
(With the seal of Office)
Date : 27/02/2025 Dhule
Printed By OMTID : VLE Name :RAHUL SANJAY KHAIRNAR, Date:27/02/2025 2:59PM
This is a digitally signed document, hence is legally valid as per the Information Technology (IT) Act, 2000.
To verify visit [Link] OR SMS “MH<space>CSC<space>VRFY<20 digit Barcode number>” to 166 from a BSNL, MTNL, Tata Mobile and
51969 from others.