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Caste Certificate

The document is a common application form for obtaining various certificates from village or taluk offices in Kerala, India. It requests details like name, address, family details, ID numbers, and birth details of the applicant and parents. The form has sections for caste, community, or inter-caste marriage certificates and a declaration by the applicant.

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273 views

Caste Certificate

The document is a common application form for obtaining various certificates from village or taluk offices in Kerala, India. It requests details like name, address, family details, ID numbers, and birth details of the applicant and parents. The form has sections for caste, community, or inter-caste marriage certificates and a declaration by the applicant.

Uploaded by

dhehi332
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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Form 1A

(see rule 3)
COMMON APPLICATION FORM FOR OBTAINING VARIOUS SERVICES FROM TALUK /
VILLAGE OFFICE
Nature of Certificate applied for …………………………………………………………………...
Purpose: □ State □ Outside State □ Defense Purpose To be produced before
…......................................................................................................
Language in which the Certificate is required: □ English □ Malayalam
Part I (General Details)

1. Name of person for whom certificate is applied for ………………………………………………...


2.Gender (M/F) ……………………………………………......................................................................
3a. Age: …............. 3b. Date of Birth: …............…..............

Details 4. Present Address 5. Permanent Address


House No:
House Name
Street / Place
Post Office
PIN code
Village
Taluk
District
Name of Local Body
Type of Local Body □ Grama Panchayat □ Municipality □ Corporation

6. Name of Father: ………………...…………….6a. Religion of Father………………….


6b. Caste of Father…………………………………………………………………….
7. Name of Mother: ………………...…………. 7a. Religion of Mother…………………
7b. Caste of Mother……………….................................................................................
8. Marital Status: □ Married □ Unmarried □ Widow □ Widower □ Divorced
9. Name of Spouse: ………………….......................................................................................................
10. Name of Guardian: .............................................................................................................................
11. No. of years residing at the present address: ………………………………………………..............
12. Phone (Res.): Code ...………… Number: ..................................... 13. Mobile: ..……………….............
14.Email: ………………………..........................................................................................
15. Ration Card No: ………………......................................................................................
16. Driving License No: ...………………………………………………………………….
7. Election ID Card No ………………...…………………………………………………...
18. Passport No: ………………...........................................................................................
19. Unique Identity No (UID), if any: ……………………………………........................

Part II A (To be filled for Caste/Community/ Conversion/Inter-Caste Marriage Certificate)


(Items 20d to 20i to be filled if caste / religion has been converted)

20a. Religion: …………….... 20b. Caste: ………………………


20c.Category: Gen/SC/ST/OBC …………........................
20d. Religion before conversion: ........................................................
20e. Caste before conversion……....................................................
20f. Name before conversion: …………………...................................
20g. Certificate No (issued by the religious authority): …………............................................
20h. Dated…………………… 20i. Religious Authority: ………………………..............................

Part II B (To be filled for Caste/Identification/Nativity /Residential/Domicile Certificates)


Enter Place of Birth details as follows:

State District Taluk Village

23.Applicant

24.Father

25.Mother
DECLARATION

I do hereby certify that the particulars mentioned above are complete and true to the best of my
knowledge and belief. I also agree that any loss to Government due to the Incomplete or Incorrect
information provided above may be recovered from my movable/ immovable assets. I also agree that
the certificate so issued and any benefits accrued in lieu of that stands nullified on proved mis-
representation.

Place: …................................. Signature: …............................................


Date: ….................................. Name of Applicant: …................................

Relationship with the person for whom certificate is


applied for…..................................................................
(Relationship to be specified if the above declaration
is signed by Parent / Guardian / Authorized Representative)

Instructions for filling the Application


1.Please enter the application particulars correctly and completely.
2.The personal details will be stored in the citizen database as part of the e-District project.
3.Filling up of e-District Registration Number is mandatory for all future correspondence.
4.In order to avail services quickly, please ensure that the information given is correct and complete.
5.Filling up of Part – I (General details) is mandatory in all applications.
6.Fill up only Part – I (General details) for Life Certificate and Destitute Certificate.
7.For additional information, please refer Kerala Information Technology (Electronic Delivery of
Service) Rules, 2010.

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