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Higher Technical Educational Courses / Engineering / Pharmacy / HMCT / Architecture / etc Diploma
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G:\SoftwareManual\OnLineSoftwareManual.doc
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Sr.No
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2
3
4
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Description
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G:\SoftwareManual\OnLineSoftwareManual.doc
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o (dd/mm/yyyy)
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Page 23 of 30
If
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declaration ! !" Done !"
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G:\SoftwareManual\OnLineSoftwareManual.doc
Page 24 of 30
! Message Ok ! <1
1 U D / < DO Message .
@ 1 E-mail 1 .
From: cv@maharashtra.gov.in [mailto:cv@maharashtra.gov.in]
Sent: Thursday, December 13, 2012 1:14 PM
To: Shri Kumaji Mansaram Gaikwad
Subject: Caste Verification Application Status
Dr. Babasaheb Ambedkar Research And Training Institute, Caste Verification Information System
--------------------------------------------------------------------------------------------Dear Shri Kumaji Mansaram Gaikwad
Your Caste verification application 52120130101000027 saved successfully.
Regards,
Caste Validation Team,
Next Steps to be followed : 1. Please fill in details of documents to be submitted along with application using option "Document Details".
2. Please fill in Caste Verification details of your relatives using option "Relative Details".
3. Please take printout of Application Form using "Print Application Form" by "Confirm/Print Application" Option.
4. Please get the photocopy of your College Identification Card duly signed and attested by the Principal. This is to
be attached with the application form.
5. Please check the application form and details about documents and relatives. If required, the applicant can
make changes using Update Application, Document Details, and Relative Details options.
6. If satisfied with the application generated by the system, please confirm your application using option
"Confirm/Print Application".
Please note that once you confirm the application, you cant make any changes to the application.
7. Please take a printout of application slip by using Application Slip option. The application slip is
to be attached to the application form while submitting to college.
--------------------------------------------------------------------------------------------This is a system generated mail. Please do not reply to this email ID
G:\SoftwareManual\OnLineSoftwareManual.doc
Page 25 of 30
D F Login F LS 1 *4Y
:-
D / Compulsory Documents
-
Optional Documents .
Compulsory Documents
4
C
x
Certified Copy
Applicant
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Documents Details: Compulsory Documents
Documents D K <1
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5 Date(dd/MM/yyyy) :- { / b .
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G:\SoftwareManual\OnLineSoftwareManual.doc
Page 27 of 30
M
Relative Name :- .
Relation with Applicant :- " {.
Scrutiny Committee :- K { < 1
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When Verification Took Place(YYYY) :- .
Was Caste Validity Certificate Granted? :- Yes {
. o No { .
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successfully added in your relatives list, please ensure that you click on Save button to
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G:\SoftwareManual\OnLineSoftwareManual.doc
Page 30 of 30
052120130101000027
Bar Code:
*052120130101000027*
avachatjb@hotmail.com
31/01/2013
3804
Scheduled Caste
3.2 Caste:
Mahar (37)
N.A
Pune
PU/PN/A.S./009(1945)
11th Science
4.5 Division:
735
(5) Scrutiny Committee Details (To which the concerned college will submit the application.)
5.1 Name of Committee:
5.2 Address of Committee:
Year of document
N.A
N.A
N.A
N.A
N.A
N.A
N.A
N.A
Certificate by the Principal of College (As per the last para of FORM-16, Rule14)
N.A
N.A
N.A
N.A
01/06/1962
Mahar
01/06/1930
Mahar
10/10/1960
Mahar
Note: 1. Application will not be accepted without the Original documents mentioned at Sr.No.1 to 3 above and the Xerox copy of the identity card
(attested by the Principal of College) mentioned at Sr. No.4 above.
2. The applicant should peruse section 8 of Maharashtra Act No. XXIII of 2001, and attach all necessary documents to prove his/her caste claim.
3. The above Act and Rules, 2012 thereunder are available on website http://barti.maharashtra.gov.in
Date of Submission of Application:
Acknowledgement by the College:
Signature of applicant:
EDUCATION
FORM-16
[ rule 14 ]
FOR STUDENTS
*052120130101000027*
Application Form for verification of Scheduled Caste / Scheduled Caste convert to Buddhism/De-Notified
Tribe (Vimukta Jati)/ Nomadic Tribe/Other Backward Class/Special Backward Category Certificate to be
submitted to Divisional Caste Certificate Scrutiny Committee.
To,
Member Secretary and Research Officer,
Divisional Caste Certificate Scrutiny Committee,
Pune Division Committee No.3, Pune,
Students Hostel,Near Commezone, Yerwada, Pune, Taluka : Pune City, District : Pune, State :
Maharashtra, Pin Code : 411006
Sub :-
Affix
Passport size
Colour
Photo
Sir,
I, the undersigned Shri Kumaji Mansaram Gaikwad hereby request to verify my Caste Certificate of Scheduled
Caste Category. Following information and documents are submitted herewith in support of my caste claim :1.
9509509509
(c) E-Mail
avachatjb@hotmail.com
(d) Institute/College
M.E.S. Abasaheb Garware College
Name :
Course Name :
11th Science
Applicant's Institute/College Division : A
Applicant's Institute/College Roll Number : 735
2.
3.
4.
01/01/1952
Pune
(b) Fathers Birth Place :
Permanent Address (If father is not alive please mention full address of his last residence.)
795 Ravivar Peth,
Laxmi Road,
Pune,
Taluka : Pune City, District : Pune, State : Maharashtra, Pin Code : 411030
1 Of 8
5.
6.
Latur
Service
7.
Father's Education
: BCom
8.
9.
: Marathi
: Marathi
1940
(d) At present who is residing at native place. Please give address and Telephone No.
Person Name :
Telephone No :
Address :
(e) Whether applicant is holding house/land at native place?
11.
No
Name of the competent authority from whom caste certificate is obtained and Certificate No. and Date.
Competent Authority : Sub Divisional Officer Pune Sub Division Pune
Certificate No:MAG/PH/SR/1462/2007
Issue Date:01-01-2004
12.
Name of the document on which basis caste certificate is obtained from competent authority.
Fathers Caste Certificate, Grand Fathers Birth Certificate
Affidavit
2 Of 8
13.
Stage of
Education
Name of Educational
Institute
Educational
Institute Address
Duration of
Education
(Year)
From
Primary
Primary
Secondary
Caste mentioned in
educational institute's
record
To
1996
2000
2001 Mahar
2001
2010 Mahar
Primary
Secondary
College
15.
16.
From
1956
To
1961 Mahar
1961
1968 Mahar
1969
1973 Mahar
If applicant/applicant's family has migrated to Maharashtra state from other State, following
information is to be furnished:Is applicant's family migrated to Maharashtra State ?
No
(a) Whether scrutiny of the caste certificate of any member of the family has been done
earlier?
Yes
(b) If Validity Certificate is received (enclose attested copy) Furnish Following Details
Name of family member
Relation
with
applicant
Father
1998
When
Validity
Validity
Scrutinized Certificate No Certificate
Date
1995
11234
01-10-1995
12356
01-10-1998
N.A
N.A
N.A
Caste Category
N.A
ii
Sub Caste
N.A
3 Of 8
(A)
Attached
Attached
Attached
Attached
Certificate by the Principal of College (As per the last para of FORM- Attached
16, Rule14)
Attested Xerox copy of identity card issued by the college
Attached
Caste Certificate issued by the Competent Authority
Attached
Attached
Attached
No
If any of the above documents are not available, then attach other relevent documents.(mention)
I am producing certified copy of above documents with my application. I declare on oath that the information furnished by
me in this application is true and correct. I am aware that incomplete application will be rejected and responsibility of
making fresh application will be of mine.
Place:
Yours,
Date :
Applicant's signature.
4 Of 8
Document Details
Document Name
Relation
Caste
Year
Father
Mahar
10-10-1960
Father
Mahar
01-06-1962
Grandfather
Mahar
01-06-1930
I am producing certified copy of above documents with my application. I declare on oath that the information furnished by
me in this application is true and correct. I am aware that incomplete application will be rejected and responsibility of
making fresh application will be of mine.
Place:
Yours,
Date :
(Signature of the Applicant's
Father/Guardian)
Applicant's signature.
5 Of 8
This is to Certify that Shri Kumaji Mansaram Gaikwad is a Student of this School/College in Year 2012-13 and he/she
is studying in 11th Science . His /Her name and other information is as per mentioned at number 3804 in general
register. And the Caste stated as per our general register is ........................................................................ .
(strike out if not applicable)
Place :Date:-
.............................................................
Seal and Signature of the Principal / Head Master
6 Of 8
FORM - 3
[rule 4 (1)]
3. Other relevant submissions to be made or any essential explanation to be made, in support of Caste /Tribe
claim, including the sociological, anthropological and ethnological (anthropological moorings and ethnological
kinship), genetical trailts, of the Caste/Tribes, if any;
To the best of my knowledge and belief the information given in the application FORM -1 and in this affidavit
is based on facts and is correct.
Place:
Date:
Signature:.............................................
(Name of the applicant/claimant)
7 Of 8
FOR STUDENTS
FORM-17
[rule 14]
I Shri/Smt.___________________________________________________________________________ age
______years, Occupation ______________________, residing at
____________________________________________________, hereby solemnly affirm today dated ____________
that Caste Certificate of my son/daughter Number _______________________ dated ______________ given by
__________________________________________________________________________ District
___________________________________ is submitted for the Scrutiny.
The documents and proofs attached with the application Form are obtained by me from Competent Authority. These
documents are true and correct and obtained by following proper procedure. No alteration / correction / change are made
in these documents. I affirm hereby that these documents are not duplicate or bogus.
*Caste Certificate of any relative from my paternal side was not invalidated by the Scrutiny Committee.
*And it is not a case that I applied before any Caste Certificate Scrutiny Committee in Maharashtra and my caste
certificate is invalidated.
I will be responsible, if the documents and proofs attached with the application form are found to be incorrect or
bogus, and I am aware that I will be liable for punishment under provision of Indian Penal Code.
I declare that the above mentioned information is true and correct, hence this affidavit.
************
8 Of 8