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Common Domicile Certificate Format

This document contains proformas for residential certificates for candidates residing in West Bengal or whose parents reside in West Bengal. Proforma A is for candidates who have resided in West Bengal continuously for at least the last 10 years. It requires information about the candidate's name, parents' name, address, and a photograph. Proforma B is for candidates not residing in West Bengal but whose parent(s) are permanent residents of West Bengal. It requires similar identifying information about the candidate and their parent(s), including photographs. Both proformas require certification by an authority, including their signature, details and an optional ID number. The certifying authority is asked to keep a duplicate copy of

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843 views

Common Domicile Certificate Format

This document contains proformas for residential certificates for candidates residing in West Bengal or whose parents reside in West Bengal. Proforma A is for candidates who have resided in West Bengal continuously for at least the last 10 years. It requires information about the candidate's name, parents' name, address, and a photograph. Proforma B is for candidates not residing in West Bengal but whose parent(s) are permanent residents of West Bengal. It requires similar identifying information about the candidate and their parent(s), including photographs. Both proformas require certification by an authority, including their signature, details and an optional ID number. The certifying authority is asked to keep a duplicate copy of

Uploaded by

droy2k
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Proforma for Residential Certificate

PROFORMA-A
Applicable to candidates residing in the State of West Bengal continuously
at least for last ten (10) years as on 30.12.2014

Certified that ___________________________________________________________ son / daughter


of ___________________________________________ is a resident/permanent resident of West
Bengal at Village/House No. ________________
Street
______________________________________________________________________________
Post Office _____________________________ Police Station ________________________________
in the District of ____________________________________________ under Assembly Constituency
__________________________________________________ and has been living in the State of West
Bengal continuously / uninterruptedly at least for the last ten (10) years as on 30-12-2014.
Paste40mmX30mm
size photograph of
applicant in this box

Note:
Photograph to be attested by the certifying authority.

Signature of Certifying Authority


________________________________________________________________
Designation with Official Seal
__________________________________________________________________
Full Name of Certifying Authority
_______________________________________________________________
Office Address
_______________________________________________________________________________
Office Phone No. _________________ Mobile No:_________________(optional)
ID No: ______________________________(optional)
Note: The Certifying Authority may please preserve the duplicate copy of the Certificate in his/her Office
provided by the candidate

Proforma for Residential Certificate


PROFORMA-B
Applicable for candidates not residing in the State of West Bengal but whose parent(s) is(are)
permanent resident(s) of West Bengal having their permanent home address within the State.
Certified that
___________________________________________________________________Father/Mother of
___________________________________________________________(the applicant) is/are
permanent resident of West Bengal at Village/House No. _____________________________ Street
____________________________

____________________________ Post Office

__________________________ Police Station _________________ ____________________________


in the District of _____________________________________ under Assembly
Constituency_________________________________________________________________________
_________
Paste 40mmX30mm
size photograph of
applicant in this box

Paste 40mmX30mm
size photograph of
Father/Mother of
applicant

Note:
Photograph to be attested by the
certifying authority.

Signature of Certifying Authority


________________________________________________________________
Designation with Official Seal
__________________________________________________________________
Full Name of Certifying Authority
_______________________________________________________________
Office Address
_______________________________________________________________________________
Office Phone No. _________________ Mobile No:_________________(optional)
ID No: ______________________________(optional)
Note: The Certifying Authority may please preserve the duplicate copy of the Certificate in his/her Office
provided by the candidate

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