12852309092002513981

FORM ­ 8
[Rule No. 5 (6)]
Form of Caste Certificate for De­Notified Tribe (Vimukt Jati)/Nomadic Tribe/Other Backward
Class/Special Backward Category person belonging to the State of Maharashtra

Documents Verified
1. Bonafide Of Beneficiary
2. Copy of Ration Card
3. School Leaving Certificate
4. Copy of School Leaving Certificate Of Father
5. Copy of Death Certificate
6. Copy of Kotwal Book
7. Copy of Aadhar Card
8. Self Declaration
9. VLE AHWAL
10 . TAX RECIEPT
11 . DEATH OF FATHER

CASTE CERTIFICATE

Outward No : 40324842099 Application Date : 09/09/2023

Rev Case No : MRC : 40324842099

This is to certify that Kumari Shamama Kausar Abdul Kalam Ansari Daughter of Shri Abdul
Kalam Ansari Nazar Mohammad of Village Nagpur (Municipal Corporation.), Tehsil Nagpur
(Urban), in the District Nagpur of the State of Maharashtra belongs to the MOMIN Caste which is
recognised as Other Backward Class at Sr No. 191 under Government Resolution CBC­1477/
35256­KA­5 dated 16/08/1977 as amended from time to time.

Kumari Shamama Kausar Abdul Kalam Ansari and/ or her family ordinarily resides in Village
Nagpur (Municipal Corporation.), Tehsil Nagpur (Urban), in the District Nagpur of the State of
Maharashtra.

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Place : Nagpur (Urban)
Date : 08/12/2023 (With the seal of Office)
Digitally Signed by
POOJA PATIL
Date:2023-12-08 10:46:24 AM
Deputy Collector / Sub Divisional Officer
Nagpur (City)

Printed By ­OMTID : VLE Name :MOHAMMAD TAQUI, Date:08/12/2023 10:41AM

This is a digitally signed document, hence is legally valid as per the Information Technology (IT) Act, 2000.
To verify visit https://www.mahaonline.gov.in/Verify OR SMS “MH<space>CSC<space>VRFY<20 digit Barcode number>” to 166 from a BSNL, MTNL, Tata Mobile and
51969 from others.