APPLICATION FORM FOR A CERTIFICATE FOR ELIGIBILITY FOR RESERVATION

OF JOBS FOR OTHER BACKWARD CLASSES IN CIVIL POSTS AND SERVICES
UNDER GOVERNMENT OF DELHI
No.
To,
… … … … … … … … … … … … … … … .
… … … … … … … … … … … … … … … .
… … … … … … … … … … … … … … … .

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Sir,
I request that a certificate in respect of reservation for other Backward Classes in Civil
Posts and Services under Government of Delhi be granted to me.
I give below the necessary particulars:1. Full Name of the applicant
(in BLOCK letters) ................................ ................................ ................................ .
2. Date of Birth ................................ ................................ ................................ ...........
3. Complete Residential Address
(a) Present................................ ................................ ................................ .............
(b) Permanent................................ ................................ ................................ ........
4. Religio n................................ ................................ ................................ ..................
5. Caste................................ ................................ ................................ .......................
6. Sub-Caste ................................ ................................ ................................ ...............
7. Occupational Group................................ ................................ ................................
8. Serial Number of the Caste in the
Central List of OBCs................................ ................................ ...............................
9. Name of Father and address ................................ ................................ ....................
................................ ................................ ................................ ...............................
10. Name of Mother................................ ................................ ................................ ......
11. Name of Husband ................................ ................................ ................................ ...
12. Status of Parent(s)/Husband ................................ ................................ ....................

(A) Constitutional Posts
Father
I.

Mother

Husband

Designation ..........................................................................................................

(B) Government Service
(i) Service (Central/State)...........................................................................................
(ii) Designation ...........................................................................................................
(iii) Scale of Pay, Including
classification, if any...............................................................................................
(iv) Date of appointment to the post .............................................................................
(v) Age at the time of promotion to Class I Post (if applicable) ...................................
II. Employment in International Organisation e.g. UN, UNICEF, WHO:
(i) Name of Organisation ......................................................................................
(ii) Designation .....................................................................................................
(iii) Period of Service ............................................................................................
(indicate date from … … … ..… … to … … … … ..… … )
III. Death/Permanent Incapacitation (Omit if not applicable)
(i) Date of death/Permanent incapacitation
putting an officer out of service .......................................................................
(ii) Details of Permanent Incapacitation.................................................................
(C) Employment in Public Sector Undertakings etc.
(i)

Name of Organisation ...................................................................................

(ii)

Designation...................................................................................................

(iii) Date of appointment to the Post ....................................................................
(D) Armed Forces including Para-military Forces
(This will not include persons holding civil posts)
(i) Designation .....................................................................................................
(ii) Scale of Pay .....................................................................................................
(E) Professional class (other than those covered in item Nos. B &C)
and those engaged in trade, Business and Industry
(i) Occupation/Profession .....................................................................................

(F) PROPERTY OWNERS
I.

Agricultural Land Holding: owned by mother father & minor children
(i) Location .............................................................................................................
(ii) Size of holding....................................................................................................
(iii) (a) Irrigated (Type of irrigated land)
(i)

............................................................................................................

(ii)

............................................................................................................

(iii)

............................................................................................................

(b) Unirrigated ...................................................................................................
To be certified by
District
Revenue
Officer not lower than
the rank of Tehsildar

(iv) Percentage of irrigated land holding to statutory ceiling
limit under State Land Ceiling Laws
(v) If land holding is both irrigated/unirrigated total irrigated
land holdings on the bases of conversion formula in State
Land Ceiling Law
(vi) Percentage of total irrigated land holding to statutory
ceiling limit as per (iv)

II. Plantation
(i) Crops/Fruit .........................................................................................................
(ii) Location .............................................................................................................
(iii) Area of Plantation...............................................................................................
III. Vacant land and/or building in urban areas or urban agglomeration
(i) Location of Property...........................................................................................
(ii) Details of Property..............................................................................................
(iii) Use to which it is put ..........................................................................................
(G) Income/Wealth
(i) Annual family income from all sources (excluding salaries & income from
agricultural land)
(ii) Whether Tax Payer (if yes, a copy of the last three years Return be furnished)
(Yes/No)
(iii) Whether covered in Wealth Tax Act (if so furnish details)
(Yes/No)

13. Any other remarks

14. I certify that above said particulars are true to the best of my knowledge and belief
and that I do not belong to the Creamy Layer of OBCs and eligible to be considered for posts
reserved for OBCs. In the event of any information being found false or incorrect, or
ineligibility being detected before or after the selection, I understand that my
candidature/appointment is liable to be cancelled and I shall be liable to such further action as
may be provided under the law and/or Rules.

Yours faithfully,

Place

Date

Signature of the candidate

----------------------------------------------------------------------------------------------------------ACKNOWLEDGEMENT RECEIPT
No.
Received application form for issue of O.B.C. Certificate from Shri/Smt./Km.
… … … … … … … … … … … … … … … … … … .. S/o/D/o/W/o … … … … … … … … … … … … … .
R/o … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … ..…
… … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … …
today on … … … … … … … … … … … … … … …
The

applicant

may

contact

S.D.M.

(… … … … … … … … … … … … … … )

on … … … … … … .. for receipt of O.B.C. Certificate.

(Full Signature of Receiving Officer with Stamp)

ANNEXURE - 1
Supporting documents required along with the application forms:S.No.

Column No. of application form

Supporting documents required to be
attached/information to be provided by applicant

1.

2 Date of Birth

Birth Certificate

2.

3 Residential Address

Copy of Ration Card or any other document such as
identity card issued by Election Office, Passport etc.

3.

7 Occupational Group Indicate

If:
(a)
(b)
(c)
(d)
(e)

Student
Service
Business
Agriculture
Others (to be specified)

4.

12:1 & 2

Certificate to be obtained from the Head of Office

5.

12-3 (Death/Permanent Incapacitation)

Death Certificate
Medical Certificate issued by the Board constituted
for the purpose or Certificate from the Department
regarding removal from Service on account of
Permanent incapacitation.

6.

12(F) (iv) (v) (vi)

Certificate from an Officer not below the rank of
Tehsildar.

7.

12(g)

Affidavit to the effect that neither he/she nor his/her
parents or any other member of his/her family is an
Income Tax Payee.

8.

To specify Trade/Business/Industry, affidavit in
case not exceeding the Income Tax limit and if
exceeding the income tax limit, income tax
assessment orders for three preceding consecutive
years.

ANNEXURE –2
LIST OF OBC CASTES FOR NATIONAL CAPITAL TERRITORY OF DELHI NOTIFIED
BY GOVERNMENT OF INDIA FOR THE POSTS RESERVED UNDER G.O.I.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.

19.
20.
21.
22.
23.
24.

Abbasi, Bhishti, Sakka
Agri, Kharwal, Kharol, Khariwal
Ahir, Yadav, Gwala
Arain, Rayee, Kunjra
Badhai, Barhai, Khait, Tarkhan, Jangra Brahmin,
Vishwakarma, Khati Panchal, Mathul Brahmin
Badi
Bairagi
Bairwa, Berwa
Barai, Bari, Tamboli
Bauria/Bawria (excluding those in SCs)
Bazigar, Nat, Kalandar (excluding those in SCs)
Bharbhooja, Kanu
Bhat, Bhatra, Darpi, Ramiya
Bhatiara
Chak
Chippi, Tonk Darzi, Idrishi(Momin), Chimba
Dakaut, Prade
Dhinwar, Jhinwar, Nishad, Kewat/Mallah
(excluding those in SCs), Kashyap (Non Brahmin),
Kahar
Dhobi (excluding those in SCs)
Dhunia, Pinjara, Kandera-Karan, Dhunnewala,
Naddati, Mansoori
Fakir
Gadaria, Gadheri, Gaddi, Garri, Pal, Bughel,
Dhangar, Nikhar, Kurba
Ghasiara, Ghosi
Gujar, Gurjar

25. Jogi, Goswami, Nath, Yogi, Jugi, Gosain
26. Julaha (excluding those in SC’s), Ansari
27. Kachhi, Koeri, Murai, Murao, Maurya,
Kushwaha, Shakya, Mahato
28. Kasai, Qassab, Quraishi
29. Kasera, Tamera, Thathiar
30. Khatgune
31. Khatik (excluding those in SCs)
32. Kumhar, Prajapati
33. Kurmi
34. Lakhera, Manihar
35. Lodhi, Lodha, Lodh, Maha Lodh
36. Luhar, Bhubhalia
37. Machi, Machhera
38. Mali, Saini, Southia, Sagarwansi-Mali, Nayak
39. Memar, Raj
40. Mina/Meena
41. Merasi, Mirasi
42. Mochi (excluding those in SCs)
43. Nai, Hajjam, Nai (Sabita), Sain, Salmani
44. Nalband
45. Naqqal
46. Pakhiwara
47. Patwa
48. Pathar Chera, Sangtarash
49. Rangrez
50. Raya-Tanwar
51. Sunar
52. Rai-Sikh

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