Professional Documents
Culture Documents
Applicants Caste Certificate No.: Caste Certificate Issuing Date: Caste Certificate Issuing District:
MAG/SR/522/2011 06/08/2011 Solapur
Designation of Caste Certificate issuing Authority: Sub Divisional Officer , Madha
Name of the Document on which Caste Certificate is Obtained from Competent Authority:
Applicant School LC/TC Father School LC/TC Self Declaration
Affidavit Bonafide Certificate Ration Card
Caste Validity Certificate in Blood Relative Photo ID of Applicant
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Mother Tongue: Marathi Regional Dialect: MARATHI God/Goddess Name: MUSLIM
Five different surnames of relatives or person from the same caste of the applicant:
2 : APPLICANT ADDRESS
Correspondence Address : Permanent Address:
SHAHUNAGAR KARAMAL TAL KARMALA DIST SHAHUNAGAR KARAMAL TAL KARMALA DIST
SOLAPUR SOLAPUR
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4 : APPLICANT'S FAMILY DETAILS
Full Name of Applicant's Father: RAJJAK BALUBHAI TAMBOLI
Permanent Address of Father (If Father is not alive, then please mention full address of his last Residence) :
SHAHUNAGAR KARMALA. TAL KARMALA DIST SOLAPUR
NA 7219387937 BUSSINESS
NA
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5 : FAMILY MIGRATION DETAILS
State Migration
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When Verification took place? : 2017 Caste Validity Certificate No. of relative: Education/38307
If applicant has applied for caste validity certificate before any committee in state of Maharashtra: Yes No
Name of Committee:
Category: Caste:
Date of Application: Committee Decision: Valid
Invalid
Pending
7 : UPLOAD DOCUMENTS
WOULD YOU LIKE TO TAKE BENEFIT UNDER BLOOD RELATION FROM PATERNAL SIDE, IF ANY? Yes No
(A) Important Primary Document (Mandatory)-Upload Scan copy of Original Certificate/ Document or upload Self Attested copy in case of Xerox.
(a-3) Original Affidavit (In Specimen Form-3, [Rule - 4(1)] Affidavit of Claimant / Parent(s))
(B) Important Secondary Documentary Evidence Proof Prior to deem Date only to Prove Caste Claim (Any one of
the document can be upload)-Upload Scan copy of Original Certificate/ Document or upload Self Attested copy in case of Xerox.
(b-1) Certified Copy of Birth Certificate of Applicant's or Applicant's Father/Real Elder Uncle/Real Aunt/Grand Father (From Paternal side) issued by Competent Authority Prior to deem Date
(b-2) Certified Copy of Applicant's Primary School Leaving Certificate/School Register's Extract
(b-3) Certified Copy of Applicant's Father Primary School Leaving Certificate/School Register's Extract
(b-4) Certified Copy of School Leaving Certificate/School Register's Extract of Grand Father/Real Elder Uncle'/
Real Aunt (From Paternal Side)
(b-5) If relatives from Paternal side are illiterate, then Birth/Death Extracts of Father/Real Elder Uncle'/ Real Aunt/Grand
Father (From Paternal Side) issued by Competent Authority (Village Extract No.14/Kotwar Book/Nationality Register)
(b-5) Any Other documents supporting Caste claim (Applicant can upload multiple VC under Blood Relation type.)
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(b-7) If any of the above documents are not available, then attach other relevant documents (mention)
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(b-8) Entry of caste mentioned in the documents of blood relatives from paternal side, registered before deemed
date of respective caste category, e.g. sale or purchase deed of land, house or other immovable property,
mortgage deed, agreement, inam sanad through which rights have been transferred
(b-9) Entry of caste of blood relatives from paternal side in National Registration Book mainly from Aurangabad Revenue Division.
(b-10) Documents related to Inam land available in the records of Directorate of Archives revealing the evidence of caste
(b-11) Entry of caste in the extract of Village Mutation Register, documents in the Format of `Ka`, `da`, `ee`, patra, entries
of caste of blood relatives from paternal side mentioned in the documents of old Court proceedings
(b-12) Government and semi-Government certificates containing traditional Occupation of caste in the old Caste System in respect
of ancestors in blood relations from paternal side, entered before deemed date.
(b-13) Old record wherein name of traditional occupation is mentioned as caste In lieu of surname.
(b-14) Sanad or Proceedings before deemed date, in which the tenant has been declared as the landlord, as per the provisions
of the Maharashtra Tenancy and Agricultural Lands Act (LXVII of 1948) or any other law, revealing the entry of caste.
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.
Date: 04-11-2020
Applicant's Father/Guardian
Signature/Left Thumb Impression
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