APPLICATION FORM FOR SCH. CASTE/ SCH. TRIBES. OBC/ MOBC/ CERTIFICATE

 

1. Name (in block letter)                                   :-

 

2. Fatherís/Husbandís Name                            :-

 

3. Present Address                                           :-

 

4. Permanent Address                                      :-

 

5. P.O. & P.S , DIST.                                      :-

 

6. Sch. Caste/ Sch. Tribe/OBC/ MOBC           :-

 

7. Religion                                                        :-

 

8. Community                                                   :-

 

9. Age                                                              :-

 

10. Purpose for which Certificate needed          :-

 

11. Remarks                                                     :-

 

12. Polling Station                                             :-

 

13. Affix 2(two) copies of Passport size photograph.

 

Text Box:    
 
    Photograph
  2(two) copies

 

     

 

 

 

 

  

  

   Part no :-

   Sl. No:-

   House no:-                                                    SIGNATURE OF THE APPLICANT

 

                                               

Verified by me.