FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD

CLASSES APPLYING FOR APPOINTMENT TO POSTS UNDER THE

GOVERNMENT OF INDIA

This is to certify that Mr. /Ms. …………..……………………………..………………….………………….

S/o. Mr.………………… ……………..……………………………..…… ………………………………...
of Village ………………………………District/Division *…………………………in the ……………….
…………………… State belongs to the………………………. Community which is recognized as a
Backward Class under*
i. Government of India, Ministry of Welfare `Resolution No. 12011/68/93-BCC (C) dated 10th
September, 1993 published in the Gazette of India Extraordinary Part-I Section-1 dated the 13th
September, 1993

ii Government of India, Ministry of Welfare Resolution No.12011/9/94-BCC dated 19.10.1994

published in the Gazette of India Extraordinary Part-I, Section-1, No. 163 dated 20.10.1994.

Shri.…………………………….and/or his family ordinary reside/(s) in the……………….

District/Division ofthe…………………………………….State.

This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) ment ioned in
Column 3 o f the Schedule to the Government of India, Department of Personnel and Training O.M. No.
36002/22/93-Estt. (SCT) dated 8.9.1993.

District Magistrate
Deputy Commissioner etc.
Date:
SEAL:

N.B.: (a) The term `Ordinarily' used here will have the same meaning as in the Section
20 of the Representation of the People's Act, 1950.

(b) Where the certificates are issued by the Gaztted Officer of the Union
Government or State Governments they should be in the same form but
countersigned by the District Magistrate or Deputy Commissioner
(Certificate issued by Gazetted Officer and attested by District Magistrate/
Deputy Commissioner are not sufficient.
* Strike out whichever is not applicable.
** Officers Competent to issue/Class/Tribe Certificates.
 I. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional
Deputy Commissioner/Deputy Collector/1st Class Stipendiary Magistrate/City
Magistrate/@Sub-Divisional Magistrate/Taluka Magistrate/Executive Magistrate/Extra
Assistant Commissioner.
@(not below the rank of Ist class Stipendiary Magistrate)
II. Chief Presidency Magistrate/Addit ional Chief Presidency Magistrate/ Presidency Magistrate:
III. Revenue Officers not below the rank of Tehsildar.
IV. Sub-Divisional Officer of the area, where the candidate and/ or his family normally reside(s)
V. Administrator/Secretary to Administrator/Development Officer (Lakshdweep)
FORM OF DECLARATION TO BE SUBMITTED BY THE OBC CANDIDATE [IN
ADDITION TO THE COMMUNITY CERTIFICATE(OBC)]

I, … … … … … … … Son/Daughter of Shri ……………………………………… resident of

village/town/city_..................................district ………………………. State hereby declare that I
belong to the …………………..community which is recognized as a backward class by the
Government of India for the purpose of reservation in services admission in Central Government
Institutions as per orders contained in Department of Personnel and Training Office Memorandum
No. 36012/22/93 – Estt. (SCT), dated 8/9/1993. It is also declared that I do not belong to
persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the above referred
Office Memorandum, dated 8/9/1993.

(SIGNATURE OF THE CANDIDATE)

FULL NAME ……………………….
ADDRESS: