FORM-C

(See Regulation No.7)

Office Of The Odisha State Commission For Backward Classes, A-2 Block,6th Floor,
Toshali Bhawan, Satyanagar, Bhubaneswar-751007
***
No. /OSCBC Dt.

To

Sir,
With reference to your application dated________________ for inclusion of
the Caste Community _____________in the list published by the State Government
of Socially and Educationally Backward Classes of Odisha, you are required to
answer the following questions.
1. What is the name of your Caste Community? -----------------------------

If it is present in some other parts of the State, please mention

The regions of its presence Local Name

2. Mention the total population of your community by quoting the source for the
previous five years.

Total Third Source of

Year Male Female Data/
population gender
Information
3. Mention the District and Tahasil wise population of your Caste Community.

Name of the Name of the

Total population Total population
District Tahasil

4. Are there any social practices that make you feel stigmatized?
Yes/ No
If yes, please give details.

5. What is the average level of education of your Caste Community?

Level of Education Average Percentage

Illiterate
Just literate
Primary
Middle
Matriculation
Intermediate
Graduation
Post-graduation
Technical Education/ Industrial Diploma

6. Please give information on occupational details of the Caste Community.

Traditional Present Occupation with percentage of people

occupation
of your Cultivator
Cultivator Non Salaried
caste with Agriculture Businessma
with own Artisan agriculture job
community leased labourer n
land labourer holder
land

6.1 What is the percentage of the representation of your Caste Community in

S.H.G.s and Cooperatives?

Category Percentage
SHGs
Cooperatives
7. Mention the percentage of representation of your Caste Community in jobs?

Private
Percentage of Percentage of
Government (Category to be
Representation Representation
mentioned)
Class - I
Class – II
Class - III
Class - IV
Contractual

8. What is the percentage of the representation of your Caste Community in

Electoral Bodies?

Percentage of
Electoral Bodies
Representation
Gram Panchayats
Panchyat Samities
Zilla Parishads
Municipal Corporations
Municipalities
Notified Area Councils (N.A.C.s)
State Legislature
Parliament

9. What is the percentage of the representation of your Caste Community in

Constitutional Posts?

Constitutional Posts Percentage of Representation

President
Vice-President
Judges of Supreme Court and High Courts
Members of Union Public Service Commission
Members of Election Commission of India
Comptroller and Auditor General of India

10. Please give an outline of the general economic condition of your Caste
Community.
 10.1 What is the average income of a family in your Caste Community?
10.2 What is the type of accommodation in which the people of your Caste
Community live generally?
No. of Government allotted
Nature of
members own Rented accommodation under
accommodation
living different scheme
Thatched House
Pucca House
Double Storeyed
Building
Apartment Building

10.3 Are the habitations accessible to the following basic infrastructure? Write it
in Yes/ No.
Basic Infrastructure Accessibility
National Highways
State Highways
Hospitals (CHC/ UHC/ DHH)
School
Market
College

Guidelines for answers:

The questions shall be answered separately for each Caste Community.
I. The reply to the questions should be precise and relevant.
II. The answer may be given either in English or in Odia.
III. Answers should be written legibly or preferably typed in double spacing.
IV. Every question bears a serial number and while furnishing the reply, that
serial number may be quoted,
V. If you intend to send documents for consideration of the Commission, they
should be sent in duplicate duly self-attested so that the original can be
returned.
VI. Those desirous of giving oral evidence to the Commission during its tours or
at its headquarters, they may kindly indicate their desire to the Commission
beforehand.
VII. A short history of the traditional occupation of the Caste Community and its
social customs and habits may be furnished.
VIII. The statement of facts must be properly verified by way of affidavit sworn
before Executive Magistrate or a Notary Public in the following manner
namely;
“that the statement in paragraphs ______________ are true to my knowledge
and belief” and in case statements are derived from information received they
shall be verified thus “that the statement in paragraphs___________ are
based on information received by me from
______________________________________(name the informant) residing
at_______________________________________ and believed by me to be
true.
IX. Reply to the questionnaire should reach the Member-Secretary, OSCBC,
Office of the Odisha State Commission for Backward Classes, A-2 Block, 6th
Floor, Toshali Bhawan, Satyanagar, Bhubaneswar-751007 before expiry of 45
days from the date of issue of this letter.
X. Name and address with dated signature of the person giving the answers
should be furnished.
XI. Answer to the questionnaire not verified in the manner indicated above or not
filed within the above, specified date or in the manner specified above will not
be taken into consideration by the Commission unless special reasons are
shown to the satisfaction of the Commission.

Member-Secretary,
Orissa State Commission for
Backward Classes, Bhubaneswar