ANNEXURE Form of Certificate to be produced by a candidate belonging o a Scheduled Caste or Scheduled Tribe in support of his claim EORM OF CASTE CERTIFIATE ‘This is to certify that Shri) Shrimatit. / Kumari son / daughter* of of village* town? in district/division*, (of the State/Union Teritory’ ‘belonging t the Pasteiibe which is recognized as & Scheduled Caste Scheduled Tribe® Under @The Constitution (Scheduled Castes) Order, 1950. @The Constitution (Scheduled Tribes) Order, 1950. @The Constitution (Scheduled Castes) (Union Territories) Order, 1951. @The Constitution (Scheduled Tribes)(Union Territories) Order, 1951. (as amended by the Scheduled Castes and Scheduled Tribes Lists Modification) Order, 1956, the Bornbxy Reorganization Act, 1960, the Punjab Reorganization Act 1966, the State of Himachal Pradesh Act 1970, the North Easter Areas (Reorganization) Act, 1971 and Scheduled Tribes Orders (Amendment) Act, 1976). @The Constitution (fammu & Kashmit) Scheduled Castes Order, 1956. @The Constitution (Hannu & Kashmir) Scheduled Tribes Order, 1989. @The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959, {@The Constitution (Dadra and Nagar Havel) Scheduled Castes Order, 1962. @The Constitution (Pondicherry) Scheduled Castes Order, 1964, @The Constitution Scheduled Tribes (Uttar Pradesh) Order, 1967. @The Constitution (Goa, Daman & Diu)Scheduled Castes Order, 1968, @The Constitution (Goa, Daman & Diu) Scheduled Tribes Order, 1968. @The Constitution (Negaland) Scheduled Tribes Order, 1970. @The Constitution (Sikkim) Scheduled Castes Order, 1978. @The Constitution (Sikkim) Scheduled Tribes Onder, 1978. 962. + Applicaton in the case of Scheduled Castes/Scheduled Tribes Persons who have migrated from one State/Union Territory: ‘This certificate is iseued on the basis of the Scheduled Caste/Scheduled Tribe _cenificate issued to Shi/Shrimatit fatherlmather. of She/Shrimati/Kumari, in DisticvDivision, of the State/Union Territory, who belonging to the casteiibe® which is recognized as 8 Schedul Scheduled Tribe In the State/Union Tervtory* issued by ___ (ame of prescribed authority) vide their No, dated %3. Sheil Shrimati/ Kumar*, and/or hiser* family ordinarily reside (6) in Village! town of, DistrievDivision of the State/Union Teniiory oF (with seal of office) Place ‘State Inion Territory Date: *Pleace delete the words which are not applicable. @ Please quote specific Presidential Order. ‘Delete the paragraph which is not applicable. NOTE : The term "Ordinarily reside(s) used here wll have the same meaning asin Section 20 of the Representation ofthe Peoples Act, 1950. ** List of authorities empowered to issue Scheduled Cast/Scheduled Tribe Certificate 1 District Magistrate/Additional District MagistrateCollector/Deputy Commissioner/Deputy Collector/Ist Cass Stipendiary “Magistrate (City Magistrate /Sub-Divisionsl Magistrate ‘Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner (not below the rank of Ist Class Stipendiary Magistrate) Chiet Presidency Magistratt/Additional Chief Presidency Magistrate/Presidency Magistrate Revenue Officers not below the rank of Tehsilder Sub-Divisional Officer of the area where the candidate and/or his family normally resides. ‘Administrtor/Secretary to Administrator/Development Officer (Lakshadweep Islands), [RS/Folder Ms Neeta Mathur/Frm of Case Certificate