LOCAL STATUS OF STUDENTS MIGRATED FROM

TELANGANA TO ANDHRA PRADESH

In terms of G.O.Ms.No.171, General Administration (SPF & MC) Department dated

20-11-2017,

“A candidate who migrates to any part of the State of Andhra Pradesh from the
State of Telangana within a period of FIVE years from the 2nd day of June, 2014
shall be regarded as the local candidate in the State of Andhra Pradesh at the
place of his residence and be treated at par with the local candidates residing in
that area, in accordance with such guidelines as may be issued by the
Government of Andhra Pradesh for the purpose of education.”

The candidate, who intends to apply for admission into Educational Institutions /
Emproyment as stated above, shall make an application in Form-I online to the
Tahsildar concerned, on or before 1s June, 2019, through Mee-Seva portal. Basing
on the documents furnished, the Tahsildar shall issue the local status certificate in
Form-III.

FORM-I

APPLICATION FORM FOR ISSUE OF LOCAL STATUS CERTIFICATE (to be

submitted online to Tahsildar of place of current residence)

(As per G.o.Ms.No.132 &

133, GA (SPF&MC) Department, dt.13,6.2016 and circular
Memo.No.4l36/SPF&MC/2015-5, Dated: 08-08-2016 & Memo.No.4136/SPF&MC/2015-9 dated 03-09-
2016)
To
Tahsildar
Sub: For issue of Local Status Ceftificate.

Sir,

I request you to kindly issue Local Status Certificate, as per the address given below, as I have migrated from
the State of Telangana and now residing at (place) since (Date/Month/year) for
District of Andhra Pradesh.

1 Full name of the applicant in block letters

2 Father’s name/Husband’s name/ Guardian’s Name
3 Aadhar Number
4 Date of Birth
5 Place of Birth
6 Caste (OC/BC/SC/ST)
7 Previous study particulars from Class-IV to Class-X
If he/she is studying, the class and address of the
8
school/college in which he/she is studying
9 Previous residential address in the state of Telangana
Present residential address with PIN in the state of Andhra
10
Pradesh
11 Mobile Number
12 E-mail address
 The period of residence / the date from which applicant is
13
residing at the above referred place.
The District to which the applicant seeks to declare
14
him / her as local candidate
15 Supporting documents enclosed (specify)

FORM-II

DECLARATION

I, s/o, d/o , w/o aged about _

years and resident of with aadhar number or
any other documents as mentioned in the guidelines hereby declare as follows:

I state that I was resident of (place) of (district), State of

Telangana (give full address with house number and PIN code) and now I migrated to the State of Andhra
Pradesh and at present I am residing in house / flat No. in
(village/town) of district, Andhra Pradesh (give full address with
house number and PIN code) from (date) _(month) (year) and desire to be
local candidate of Andhra Pradesh for Education and Employment purpose.

I am further to declare that the Facts mentioned above and in Form-I are true and correct to the best of
my knowledge and belief.

I am further to state that if the information furnished in Form-I i.e., application, and this declaration i.e.,
Form-II, is found to be false/incorrect, I am liable for prosecution and for cancellation of any employment
in Government / Organisation or seat in any Educational Institution / University, obtained, based on the
local status certificate.

SIGNATURE OF THE APPLICANT

(In case applicant is minor, parent/guardian shatl also make following declaration
apart from the applicant’s declaration)

I, F/o, M/o, G/o aged about-------------years bearing Aadhar No.

and resident of hereby declare that the above information and declaration furnished by the
applicant is true and correct to the best of my knowledge and belief. If the information and declaration
furnished is found false, I am liable for prosecution.
 SIGNATURE OF PARENT/GUARDIAN OF THE APPLICANT

FORM-III
LOCAL STATUS CERTIFICATE
(As per G.o.Ms.No.132 & 133, GA (SPF&MC) Department, dt.13,6.2016 and circular
Memo.No.4l36/SPF&MC/2015-5, Dated: 08-08-2016 & Memo.No.4136/SPF&MC/2015-9 dated 03-09-
2016)

[vide sub-paragraph (3) of paragraph 4 of the Andhra Pradesh Educational Institutions (Regulation of
Admissions) order 1974 and vide sub-paragraph (3) of paragraph (7) of the Andhra Pradesh Public Employment
(organization of local cadres and regulation of Direct Recruitment) Order, 1975.]

This is to certify that the candidate whose particulars are mentioned below is
declared to be local candidate of district of Andhra Pradesh.

1 Full name of the applicant in block letters

2 Father’s name/Husband’s name/ Guardian’s Name
3 Aadhar Number
4 Date of Birth
5 Place of Birth
6 Caste (OC/BC/SC/ST)
7 Previous study particulars from Class-IV to Class-X
If he/she is studying, the class and address of the
8
school/college in which he/she is studying
9 Previous residential address in the state of Telangana
Present residential address with PIN in the state of Andhra
10
Pradesh
11 Mobile Number
12 E-mail address
The period of residence / the date from which applicant is
13
residing at the above referred place.
The District to which the applicant seeks to declare
14
him / her as local candidate

(The above certificate is issued basing on FORM-I & the declaration furnished by the candidate/
parent/ guardian in FORM-II. If, the information furnished in Form-I & the declaration in Form-II are found
false, this certificate shall stand cancelled and he/she shall be liable for prosecution.)
*(This certificate in Form-III is meant for only Local Status and it does not confirm the rest of the
information in the certificate)