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OBC N

ANNEXURE - B

APPLICATION FORM FOR CERTIRICATE OF ELIGIBILITY FOR RESERVATIOS

UNDER
OF JOBS FOR THE OTHER BACKWARD CLASSES IN CIVIL POSTS AND SERVICES
CENTRAL GOVT. OF INDIA

Sir,

I request you a CERTIFCATE in respect of Reservation for BACKWARD

CLASSES in civil POSTS & SERVICES under Government of India be granted to me.
L. Given below of the necessary particulars
1. Full name of the Applicant mounish
(In BLOCK LETTERS)
2 Gender : male
3. Date of Birth O- o 4-20o
Complete Resident Address
4.
a) PERMANENT Amadog
DNe:2ajo Loaliy, Amad vilager Amae
Mandal:Ada District: si sathyaBincode:
b) PRESENT (Postal-Address)
Village: A
D.No: -
Mandal:A Localityr
District:s A Pincode: suSs
5. Religion
6. Caste : Bc-A
7. Sub-Caste Donmara
8 Issued Caste Certificate In Past YES/NO
9. Education Certificate Contains Caste YESNO
10. Occupation Group
11. SERIAL NUMBER of the Caste in the
CENTRAL LIST OF OBCs
12. Name of the Father
13. Name of the Mother
14. Name of the Husband
15. Status of the Parents(S) / Husband Father/ Mother/
Husband wife
a) Constitutional Posts
b) Designation
c) i) Services: CENTRAL / STATE
i) Designation
CENT24c
ii) Scale of Pay, including
Clarification if any
iv)Date of Appointment of Post
v) Age of the time of Promotion
to Class I post (if applicable)
II EMPI ÔVMCNT IN ITEDNA TION AT ADGA NITNATIONN EoHY
 Application
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4)Procedure Dated:
Place: G. F.
Applicant Ration
Particulars/ 21. 20. 19. 18. 17. 16.
befound
false be
understand I or and ii. ii /WEALTH
INCOME
i. ii. i . i. III.
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Father/
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Details of of
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