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TSMSAA 19880884
GOVERNMENT OF TELANGANA
REVENUE DEPARTMENT
FORMIii A

Community Serial No 1 2 Application No

BC
District Code 28
Mandal Code: 28 CNDO21708297621
Village Code 063 Date: 19/05/2017

COMMUNITY AND DATE OF BIRTH CERTIFICATE

1.This is to certify that the Sri/Srimathi/Kumari MOHAMMED SHOAIB S/o/ D/o / M/o / F/o / W/o/ H/o/
C/o Sri. ABDUL RASHEED of Tandur (M) vilage/ Town of Tandur Mandal of VIKARABAD District of the
TelanganaState belongs to Shaik-12(BCE) Community which is recognized as B.C under:
The Constitutuion (Scheduled Castes) Order, 1950
The Constitutuion (Scheduled Tribes) Order, 1950
G.O.Ms.No. 1793,Education,dated 25-9-1970 as amended from time to time (BCs) S.Cs.,5.Ts.list
(Modification) Order, 1956,S.Cs and S.T.s(Amendment) Act, 1976.

2.It is certified that the date of birth Sri/Srimathi/Kumari MOHAMMED SHOAIB is day 15 Month
FEBRUARY Year 2001 (in words) One Five-FEBRUARY Two Zero Zero One as per the declaration
given by his/her Father/Mother/ Guardian and as entered in the School records where he/she studied.

Certified By

Name: G RAMULU
Designation: TAHSILDAR
Mandal: Tandur
Note: Thiss Digitaly Signed Certificate, does not require physical signature. And this certificate can be vertfied at
http://www.tg.meeseva.gov.in/ by furnishing the appication number mentioned in tlie Certificate.

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