17
Annexure – “B”
PROFORMA FOR CASTE CERTIFICATE FOR SC/ST APPLICANTS
(Format of certificate to be produced by a Applicants belonging to Scheduled Castes or Scheduled Tribes in support of
Claim)
This is to certify that Shri / Smt. / Kum* ______________________________ Son / Daughter* of
___________________________ of village / town* _________________ District / Division*___________________ of State /
Union Territory* ___________ belongs to the ___________________ Caste / Tribe* which is recognized as a Scheduled Caste /
Scheduled Tribe* under :
• The Constitution (Scheduled Caste) / (Scheduled Tribes) Order, 1950.
• The Constitution (Scheduled Caste) (Union Territories) Order, 1951.
• The Constitution (Scheduled Tribes) (Union Territories) order, 1951 (as amended by the Scheduled Caste and Scheduled
Tribes Lists Modification), Order, 1956. The Bombay Re-Organisation Act 1960, The Punjab Re-Organisation Act, 1966,
The State of Himachal Pradesh Act, 1970, The North Eastern Areas Re-Organisation Act, 1971, and the Scheduled Caste
/ Scheduled Tribes Order (Amendment) Act, 1976.
• The Constitution (Jammu and Kashmir) Scheduled Caste / Scheduled Tribe Order, 1956.
• The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959.
• The Constitution (Dadra and Nagar Haveli) Scheduled Castes / Scheduled Tribes Order, 1962.
• The Constitution (Pondicherry) Scheduled Castes Order, 1964.
• The Constitution Scheduled Tribes (Uttar Pradesh) Order, 1967.
• The Constitution (Goa, Daman and Diu) Scheduled Castes / Scheduled Tribes Order, 1968.
• The Constitution (Nagaland) Scheduled Tribes Order, 1970.
• The Constitution (Sikkim) Scheduled Caste / Scheduled Tribes Order, 1978.
• The Constitution (Jammu and Kashmir) Scheduled Tribes Order, 1989.
• The Constitution (SC) Orders (Amendment) Act, 1990.
• The Constitution (ST) Orders (Amendment) Act, Ordinance 1991.
• The Constitution (ST) Orders (Second Amendment) Act, 1991.
• The Constitution (ST) Orders (Amendment) Ordinance, 1996.
2. Application in the case of Scheduled Caste / Scheduled Tribe Persons who have migrated from One State / Union Territory
Administration.
This certificate is issued on the basis of Scheduled Caste / Scheduled Tribe certificate issued to Shri / Smt. / Kum*
_______________________ Father / Mother of Shri / Smt. / Kum ______________________ of Village / town in District /
Division* _____________________ of State / Union Territory _________________ who belongs to the ________________
Caste / Tribe* which is recognized as a Scheduled Caste / Scheduled Tribe * in State / Union Territory *
__________________issued by the __________________(Name of prescribed authority) vide their No. _____________
dated _______________.
3. Shri / Smt. / Kum.*____________and or his / her* family ordinarily reside(s) in village /
town*________________________________________of____________________District / Division of State / Union
Territory of________________ Place ____________________ State / Union Territory of
Signature __________
Designation _________
(With Seal of Office)
(*) Please delete the words which are not applicable (*) Please quote specific presidential offer (*). Delete the
Paragraph which is not applicable. (*)
Please Note: The term *Ordinarily resides* used 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 :
1. District Magistrate / Additional District Magistrate / Collector / Deputy Commissioner / Additional Deputy
Commissioner / Deputy Collector / 1
st
Class Stipendiary Magistrate / Sub Divisional Magistrate / Taluka
Magistrate / Executive Magistrate / Extra Assistant Commissioner.
2. Chief Presidency Magistrate/additional Chief Presidency Magistrate/Presidency Magistrate.
3. Revenues Officers not below the rank of Tehsildar.
4. Sub Divisional Officer of the area where the Applicants and / or his family normally resides.