CASTE CERTIFICATE

APPLICATION FORM
To

The MandaI Revenue Officer,

QUTHBULLAPUR _ Mandal,
MEDCHAL _ Dist.

1 Applicant Aadhar Number

2 Name of the Applicant
3 Father/Husbands Name
4 Mother Name
5 Sex of the Applicant
H.No

6 Present Address
QUTHBULLAPUR MANDAL, MEDCHAL DIST TELANGANA - 500055
7 Date of Birth
8 Religion
Community for Which Caste: Sub Caste Group Sl. No
9 Caste is Claimed
(Including Sub Caste) BC – SC - ST
10 Weather Applicant is Natural Born / Adopted Child
11 Mobile No

I / We declare that the information furnished by me/us in the application is true and Correct, and the
documents appended thereto are genuine and the contents of the Documents are true and correct and that if these
are found to be untrue and incorrect, I/We Will be liable for prosecution for furnishing false and incorrect information
documents under Section 10 of the Act No.16 of 1993.

Signature of the Applicant

Date :

Signature of the Parent/Guardian

Documents Enclosed (Please Tick Which ever Enclosed):
1. Applicant Aadhar Card & Father/ Husband Aadhaar
2. Previous Caste Certificate / Community Letter with Affidavit.
3. Study Certificate / SSC Memo/ T.C
4. Electricity / Gas Bill
5. Ration Card

SURESH COMMUNICATIONS
MEESEVA, CSC, PAN CENTER, INCOME TAX FILING, COURIER AND ALL RTA WORKS
#Plot No 86, Ushodaya Colony Phase 2, UMCC Back Side, Chandragiri Nagar Road, Gajularamaram, Quthbullapur
Mandal, Medchel - Malkajgiri 500055.
Ph 8520814050, 9989177126