Scheduled Caste Certificate - Delhi

REVENUE DEPARTMENT, GOVT. OF NCT OF DELHI
APPLICATION FORM FOR SCHEDULED CASTE CERTIFICATE
Warning: It is an offence to give false information in this form.
1. AADHAAR No. :
(If AADHAAR not available, provide information of 2a and 2b)
2a.Enrolment No.: ___________________________________
Any one - PAN/Voter Card/I-Card/Passport/DL/Other-specify
2b.ID Proof No.: _____________________________________
3. Mobile No. :
1. Name (in BLOCK letters) : __________________________________________________
2. Father’s / Husband’s Name :__________________________________________________
3. Permanent Address :__________________________________________________
____________________________________________________________________________
4. Complete present address with name of Police Station :______________________________
___________________________________________________________________________
5. Ration Card Number : ______________________________________________________
6. Date and place of birth :_______________________________________________________
7. Is he/she scheduled caste since birth or by adoption : ____________________________
8. Nationality :_____________________________
9. Caste : ______________________________
10. Religion :______________________________
11. Duration of stay in Delhi (with date) :
Date Month Year
12. Complete address of father before migration to Delhi :
13. If migrated after or before 20-09-1951 in Delhi, give :
Date of migration
Date Month Year
14. The state to which ancestors belong to : ______________________________
15. Educational Qualification : ______________________________
16. Name of School / College last attended : ______________________________
(attach an attested copy of the Education Certificate)
17. Purpose for which the certificate is required : ______________________________

18. Have your parents/or any of your family member
been is issued Scheduled Cast Certificate from
Delhi. If so, attach an attested copy of that
S.C. Certificate:
_______________________________
19. Have you obtained scheduled caste certificate from
Delhi or any other State? Give the answer in Yes or No: ____________________________
If Yes please give full detail
20. Name and Address of the respectable person of the locality
. (1) Full Name (in BLOCK letters): _______________________________________________
Full address (House No., Street, Locality): _____________________________________
______________________________________________________________________
(2) Full Name (in BLOCK letters) : ______________________________________________
Full address House No., Street, Locality): _____________________________________
______________________________________________________________________
Signature of the Applicant
Declaration:
(To be signed by applicant if he/she attained the age of 18 years. In case he/she is minor it will be signed
by father/guardian of the applicant)
I, … … … … … … …… … … … … … … … … …, son of/daughter of/ wife of… … … …..… … … … … … … … …do
hereby declare that the facts given in the application are correct and nothing has been concealed there
from.
Signature of the applicant
Name and relationship with the applicant ________________________
Caution: It is an important document and should be attested on the basis of personal
knowledge. If the scheduled caste certificate is issued on the basis of wrong attestation then the
action can be taken against the attestator under Indian Penal Code.

ATTESTION
I certify that Shri/Km./Smt. … … … … … … … … … … … … … … … … …
… .son of/daughter of/wife of … … … … … … … … … … … … … … … … … .
is known to me for the last … … … … … … … … years and he/she belongs to …
… … … … … … … caste and he/she was born at … … … … … … … … … …
… … (place of birth). I also certify personally that the facts given in this form are
correct.
Signature of the Attestator
Name of Attestator (in BLOCK Letters)_________________________
Office Address with Tel no. :______________________________________
Full Residential Address:______________________________________.
______________________________________________________
The above attestation can be done by any of the following officers:-
1. Member of Parliament/MLA/Councillor
2. Gazetted Officer of Delhi Govt. /Central Government.
3. Police Officer not below the rank of D.S.P.

List of supporting documents - (Maximum time limit – 60 days)
• Completed application form duly attested by MP/ MLA//Councillor/Gazetted officer.
• AADHAR No., if AADHAR No. is not available, provide the AADHAR Enrolment No. and any
one of the identity proof PAN / PASSPORT / Driving Licence / Voters Card / Identity Card.
The name of the applicant on the AADHAR card should match with the Name of the
Applicant.
• The photograph of the applicant will be captured through web camera at the time of
submission of application or at the time of verification. The Photograph of the applicant
should match with photo of the applicant on the AADHAAR.
• A copy of SC/ST certificate of father, brother, sister or of his/her blood relative from paternal
side.
• Affidavit in case of SC/ST certificate issued from outside Delhi in prescribed Performa
attested by executive magistrate (Affidavit from the major if the children are below the 18
years.)
• If certificate of father, brother, sister or of his/her blood relative from paternal side is not
available, two attestations by MP/MLA and Gazetted Officers, declaring the caste of
applicant.
• Supporting document for the present residential proof like Voters Card, Electricity Bill, Water
Bill, Telephone Bill etc.
• Proof of Date of Birth (Birth certificate, School certificate or passport)
• The migrants SC members whose caste are listed in SC list of Delhi should be issued caste
certificate as original resident of Delhi if any of the following
o Birth Certificate (born in Delhi.)
o Matriculation Certificate (studied in Delhi)
Note: All supporting documents must be attested by MPs/MLAs and Gazetted officer.