R.C. Office / N.I.C. Office, Belgaum
retired, if so, how long did heremain in the State of Karnatakaafter retirement?e) If your father is dead, had heretired before his death, if so, howlong did he remain in the State of Karnataka after retirement.f) Has or had your father ormother any immovable property inthe State of Karnataka or elsewhere? If so, where and of whatdescription and value?5 Have or had you any brother orsisters, if so, how many? Wherewere they being educated? Whereare they now and what are they now and what are they doing? If any of them are dead, where didthay died and what were theiroccupations?6 Have you ever claimed beendeemed to be a native of any placeother than a place in the State of Karnataka for the purpose of yourappointment to any office or forconfirment upon you of any scholarship, or other privileges inthat place.7 a) For what purpose is theCertificate of Domicile Required?b) What is your religion?c) Are you a member of aScheduled Caste or a Scheduled Tribe or a community classified asa backward by the State Govt.(Answer Yes or No)d) If the answer to (b) above is yes,give particulars.e) Did you apply for a certificate of Domicile at any time before and if so, when?Place:Date:Signature of ApplicantN.B. :
If it is found that the replies given by the applicant to the questions,set above, or to any of them are incorrect any admission obtained orbenefit derived thereby shall be summarily concelled.