GOVERNMENT OF KARNATAKA

REVENUE DEPARTMENT
PHOTO
FORM-D
Scheduled Caste/Scheduled Tribes Certificate

Certificate No: RD0038181297949 *RD0038181297949*

This is to certify that Kumar.RAVI S/OSri.BORE NAYAKA(Father Name) is a resident of
HAVAMBHAVI NEAR, ANJINEYA TEMPLE SIRUGUPPA ROAD, BALLARI Tq DIST, inBallari(Ward
No 35 )Ward, Ballari Taluk, Ballari Hobli, Ballari District, in the state of Karnataka, belongs to the Caste / Tribe*
Schedule Tribe(Valmiki) which is recognized as Scheduled Caste/Scheduled Tribe under :-.
* The Constitution (Scheduled Castes) Order, 1950
* The Constitution (Scheduled Tribes) Order, 1950
Kumar. RAVI S/OSri. BORE NAYAKA and / or his/her family are ordinary resident (s) in Ballari (Ward
No 35)Ward of Ballari District of the State of Karnataka.
This certificate is valid for life time
Date:01/02/2016
Note : This is a digitally signed certificate and does not
require manual signature.

Please, verify authenticity of this certificate by visiting

www.nadakacheri.karnataka.gov.in & entering
certificate Number or by SMSing KA NK <certificate
Number> to 51969.
Name: HONNAMMA H
Tahsildar
Ballari Taluk
BallariDistrict

This Certificate can be Verified at www.nadakacheri.karnataka.gov.in Ver:4.1