Annexure-2

FORM OF CASTE CERTIFICATE FOR SC/ST

The format of the certificate to be produced by Scheduled Castes or Scheduled Tribes candidates applying for appointment to
posts under the Government of India.

This is to certify that Shri /Shrimati/Kumari* ................................ ...................................................................................... …………...

son/daughter* of …………….. ....................................................... of Village / Town* ...................................................... …………in
District/Division* ......................................................... of State / Union Territory* ………………………………………….belongs to
the…………………………………..Caste / Tribe* which is recognised as a Scheduled Caste / Scheduled Tribe* under:-
The Constitution (Scheduled Castes) Order, 1950
The Constitution (Scheduled Tribes) Order, 1950
The Constitution (Scheduled Castes) (Union Territories) Order, 1950
The Constitution (Scheduled Tribes) (Union Territories) Order, 1951
(As amended by the Scheduled Castes and Scheduled Tribes Lists (Modification) Order, 1956, the Bombay Re-organisation
Act, 1960, the Punjab Re-organisation Act, 1966, the State of Himachal Pradesh Act, 1970 and the North Eastern Area (Re-
organisation) Act, 1971 and the Scheduled Castes and Scheduled Tribes Orders,(Amendment) Act, 1976)
The Constitution (Jammu & Kashmir) Scheduled Castes order, 1956.
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 @ as amended by the Scheduled Castes
and Scheduled Tribes Order (Amendment)Act, 1976.
The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962.
The Constitution (Dadra and Nagar Haveli) Scheduled Tribes, Order, 1962@
The Constitution (Pondicherry) Scheduled Castes Orders, 1964@
The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1967@
The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968@
The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968@
The Constitution (Nagaland) Scheduled Tribes Order, 1970@
The Constitution (Sikkim) Scheduled Castes Order, 1978@
The Constitution (Sikkim) Scheduled Tribes Order, 1978@
The Constitution (Jammu & Kashmir) Scheduled Tribes order 1989@
The Constitution (SC) orders (Amendment)Act,1990@
The Constitution (ST) orders (Amendment) Ordinance 1991@
The Constitution (ST) orders (Second Amendment) Act, 1991@
The Constitution (ST) orders (Amendment) Ordinance 1996.

% 2. Applicable in the case of Scheduled Castes, Scheduled Tribes persons who have migrated from one State/Union Territory Administration.
This certificate is issued on the basis of the Scheduled Castes/Scheduled tribes certificate issued to Shri/Shrimati _________________
___________ Father/mother of Shri/Srimati/Kumari* _________________________________ of village/town*________________
in District/ Division* _______________________ of the State/Union Territory*__________________________ who belong to the
_____________Caste/Tribe which is recognized as a Scheduled Caste/Scheduled Tribe in the State/Union Territory* issued by the
_____________ dated______________.

%3. Shri/Shrimati/Kumari * ___________________________and / or his / her* family, reside(s) in village/town* _______________

of*______________District/Division* of the State / Union Territory* of ________________________________.

Signature ......................................................................
**Designation .............................................................. .
(with seal of Office)
Place……………………..
Date …. ........................... .
* Please delete the words which are not applicable.
@ Please quote specific Presidential Order.
% Delete the paragraph which is not applicable.

NOTE: The term, ordinarily reside(s) used here will have the same meaning as in section 20 of the Representation of the People Act, 1950.
** List of authorities empowered to issue Caste/Tribe Certificates:
(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Dy. Collector/
Ist Class Stipendiary Magistrate/Sub-Divisional Magistrate/Extra-Assistant Commissioner/Taluka Magistrate/Executive Magistrate.
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officers not below the rank of Tehsildar.
(iv) Sub-Divisional Officers of the area where the candidate and/or his family normally resides.
NOTE: ST candidates belonging to Tamil Nadu state should submit caste certificate ONLY FROM THE REVENUE DIVISIONAL OFFICER.
 Annexure-3
OBC CERTIFICATE FORMAT

FORMAT OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES

APPLYING FOR APPOINTMENT TO POST UNDER THE GOVERNMENT OF INDIA.

This is to certify that Shri/Smt/Kum*_____________________________________________________________________

Son/Daughter* of Shri __________________________________ of Village /Town ________________________________
District ___________________ in __________________________ State belongs to ______________________ community
which is recognized as backward class under___________________: (indicate the Sub Caste)
1. Resolution No. 12011/68/93-BCC@dtd 10th September 1993, published in the Gazette of India- Extraordinary Part-I, Section 1.
No. 186 dated 13th September 1993.
2. Resolution No. 12011/9/94-BCC dated 19th October 1994, published in the Gazette of India-Extraordinary Part-I, Section I. No.
163, dated 20th October 1994.
3. Resolution No. 12011/7/95-BCC dtd 24th May 1995, Published in the Gazette of India-Extraordinary Part-I, Section I. No. 88
dated 25th May 1995.
4. Resolution No. 12011/44/96-BCC dtd 6th December 1996, published in the Gazette of India-Extraordinary Part-I, Section I. No.
210, dated 11th December 1996.
5. Resolution No. 12011/68/93-BCC, Published in Gazette of India – Extra Ordinary – No. 129, dated the 8th July 1997.
6. Resolution No. 12011/12/96-BCC, Published in Gazette of India – Extra Ordinary – No. 164 dated the 1st Sept. 1997.
7. Resolution No. 12011/99/94-BCC, Published in Gazette of India – Extra Ordinary – No. 236 dated the 11th Dec. 1997.
8. Resolution No. 12011/13/97-BCC, Published in Gazette of India – Extra Ordinary – No. 239 dated the 3rd Dec. 1997.
9. Resolution No. 12011/12/96-BCC, Published in Gazette of India – Extra Ordinary – No. 166 dated the 3rd August 1998.
10. Resolution No. 12011/68/93-BCC, Published in Gazette of India – Extra Ordinary – No. 171 dated the 6th August 1998.
11. Resolution No. 12011/68/98-BCC, Published in Gazette of India – Extra Ordinary – No. 241 dated the 27th Oct. 1999.
12. Resolution No. 12011/88/98-BCC, Published in Gazette of India – Extra Ordinary – No. 270 dated the 6th Dec. 1999.
13. Resolution No. 12011/36/99-BCC, Published in Gazette of India – Extra Ordinary – No. 71 dated the 4th April 2000.

Shri/Smt/Kum*_____________________________________________________ and / or his/her family ordinarily reside(s) in the

____________________________District of the___________________________State. This is also to certify that he/she does not
belong to the persons / sections (Creamy Layer) mentioned in Column 3 (of the Schedule to the Government of India, Department of
Personnel and Training O.M. No. 36012/22/93/Estt. (SCT) dated 08.09.1993) and modified vide Government of India, Department
of Personnel and Training O.M. No. 36033/3/2004/Estt.(RES). dated 09.03.2004.

District Magistrate/
Place: Dy. Commissioner etc
Date: (with seal of office)

________________________________________________________________________________________________________

a. The term ordinarily used here will have the same meaning as Section 20 of the representation of the People Act. 1950.
b. Where the certificates are issued by Gazetted Officers of the Union Government or State Governments, they
should be in the same form but countersigned by the District Magistrate or Dy. Commissioner (Certificates
issued by Gazetted officers and attested by District Magistrate/Deputy Commissioner are not sufficient).
c. The OBC certificate from the authorities only will be accepted.
1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy
Commissioner/Deputy Collector /I" Class Stipendiary Magistrate/Extra-Assistant Commissioner (not
below the rank of l" Class stipendiary Magistrate)/ *Subdivisional Magistrate/Taluka
Magistrate/Executive Magistrate.
2. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
3. Revenue Officer not below the rank of Tahsildar, and
4. Sub-Divisional officer of the area where the candidate and/or his family normally resides.
 Annexure-4

The form of Certificate to be produced by Physically Handicapped Candidates

applying for appointment to posts under the Government of India

NAME & ADDRESS OF THE INSTITUTE / HOSPITAL

Certificate No. __________________ Date: ______________

DISABILITY CERTIFICATE Recent

Photography of
the candidate
showing the
disability duly
attested by the
Chairperson of the

This is certified that Shri / Shri / Kum ___________________________

son/wife/daughter of Shri _________________ age __________ sex _______
identification mark(s) __________ is suffering from permanent disability of following
category:

A. Locomotor or cerebral palsy:

(i) BL-Both legs affected but not arms

(ii) BA-Both arms affected (a) Impaired reach

(b) Weakness or grip

(iii) BLA-Both legs and both arms affected

(iv) OL-One leg affected (right or left) (a) Impaired reach.

(b) Weakness of grip
(c) Ataxic

(v) OA-One arm affected (a) Impaired reach

(b) Weakness of grip
(c) Ataxic

(vi) BH –Stiff back and hips (cannot sit or stoop)

(vii) MW-Muscular weakness and limited physical endurance.

B. Blindness or Low vision:

(i) B-Blind
(ii) PB – Partially Blind
C. Hearing impairment:

(i) D-Deaf
(ii) PD-Partially Deaf

(Delete the category whichever is not applicable)

2. This condition is progressive / non-progressive / likely to improve / not likely to

improve. Re-assessment of this case is not recommended / is recommended after a period
of ________ years _____ months.*

3. Percentage of disability in his/her case is _____ percent.

4. Sh./Smt./Kum. _____________________ meets the following physical requirements

for discharge of his/her duties;-

(i) F-can perform work by manipulating with fingers Yes/No

(ii) PP-can perform work by pulling and pushing Yes/No

(iii) L-can perform work by lifting Yes/No

(iv) KC-can perform work by kneeling and crouching Yes/No

(v) B-can perform work by bending Yes/No

(vi) S-can perform work by sitting Yes/No

(vii) ST-can perform work by standing Yes/No

(viii) W-can perform work by walking Yes/No

(ix) SE-can perform work by seeing Yes/No

(x) H-can perform work by hearing/speaking Yes/No

(xi) RW-can perform work by reading and writing Yes/No

(Dr________________) (Dr________________) (Dr________________)

Member Member Chairperson

Medical Board Medical Board Medical Board

Countersigned by the

Medical Superintendent / CMO/Head of

Hospital (with seal)

*Strike out which is not applicable