FORM- 15 A

CERTIFICATE TO BE ISSUED BY HEAD OF ESTABLISHMENT/INSTITUTION

FROM WHOM BENEFIT IS TO BE GIVEN

This is to certify that Shri/Shrimati……………………………………………………………………… has

been selected for…………………………benefit under…………………………caste/tribe. For
providing………………. benefit under Scheduled Caste/ De-Notified Tribes (Vimukta Jatis)
Nomadic Tribes/Other Backward Class/Special Backward Category, Caste validity Certificate
is essential as per Government Notification
No…………………………………………...dated…………………..
It is requested to scrutinize the Caste Claim of the Candidate and communicate
within a period of 6 months, enabling us to provide the said benefit.

Place:

Date: Sign, and Stamp of the Head of the Department

Important Instructions: -
a) If Claim for Scheduled Caste, Caste evidences should be prior to 10th August 1950.
b) If Claim for De-Notified Tribes (Vimukta Jatis), Nomadic Tribes Caste evidences should
be prior to 21st November 1961.
c) If Claim for Other Backward Class and Special Backward Category, Caste evidences
should be prior to 13th October 1967.
d) In addition, evidence of residents of above mentioned prior is essential for applicant
who has migrated in Maharashtra from other State.
e) Migrants from other State to Maharashtra after above mention period whose Caste
Certificate is in “Migrants” format should not apply to committee.