Scheduled Caste Certificate - Delhi
Scheduled Caste Certificate - Delhi
Scheduled Caste Certificate - Delhi
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REVENUE DEPARTMENT, GOVT. OF NCT OF DELHI<br />
APPLICATION FORM FOR SCHEDULED CASTE CERTIFICATE<br />
Warning: It is an offence to give false information in this form.<br />
1. AADHAAR No. :<br />
(If AADHAAR not available, provide information of 2a and 2b)<br />
2a.Enrolment No.: ___________________________________<br />
Any one - PAN/Voter Card/I-Card/Passport/DL/Other-specify<br />
2b.ID Proof No.: _____________________________________<br />
3. Mobile No. :<br />
1. Name (in BLOCK letters) : __________________________________________________<br />
2. Father’s / Husband’s Name :__________________________________________________<br />
3. Permanent Address :__________________________________________________<br />
____________________________________________________________________________<br />
4. Complete present address with name of Police Station :______________________________<br />
___________________________________________________________________________<br />
5. Ration Card Number : ______________________________________________________<br />
6. Date and place of birth :_______________________________________________________<br />
7. Is he/she scheduled caste since birth or by adoption : ____________________________<br />
8. Nationality :_____________________________<br />
9. <strong>Caste</strong> : ______________________________<br />
10. Religion :______________________________<br />
11. Duration of stay in <strong>Delhi</strong> (with date) :<br />
Date Month Year<br />
12. Complete address of father before migration to <strong>Delhi</strong> :<br />
13. If migrated after or before 20-09-1951 in <strong>Delhi</strong>, give :<br />
Date of migration<br />
Date Month Year<br />
14. The state to which ancestors belong to : ______________________________<br />
15. Educational Qualification : ______________________________<br />
16. Name of School / College last attended : ______________________________<br />
(attach an attested copy of the Education <strong>Certificate</strong>)<br />
17. Purpose for which the certificate is required : ______________________________
18. Have your parents/or any of your family member<br />
been is issued <strong>Scheduled</strong> Cast <strong>Certificate</strong> from<br />
<strong>Delhi</strong>. If so, attach an attested copy of that<br />
S.C. <strong>Certificate</strong>:<br />
_______________________________<br />
19. Have you obtained scheduled caste certificate from<br />
<strong>Delhi</strong> or any other State? Give the answer in Yes or No: ____________________________<br />
If Yes please give full detail<br />
20. Name and Address of the respectable person of the locality<br />
. (1) Full Name (in BLOCK letters): _______________________________________________<br />
Full address (House No., Street, Locality): _____________________________________<br />
______________________________________________________________________<br />
(2) Full Name (in BLOCK letters) : ______________________________________________<br />
Full address House No., Street, Locality): _____________________________________<br />
______________________________________________________________________<br />
Signature of the Applicant<br />
Declaration:<br />
(To be signed by applicant if he/she attained the age of 18 years. In case he/she is minor it will be signed<br />
by father/guardian of the applicant)<br />
I, … … … … … … …… … … … … … … … … …, son of/daughter of/ wife of… … … …..… … … … … … … … …do<br />
hereby declare that the facts given in the application are correct and nothing has been concealed there<br />
from.<br />
Signature of the applicant<br />
Name and relationship with the applicant ________________________<br />
Caution: It is an important document and should be attested on the basis of personal<br />
knowledge. If the scheduled caste certificate is issued on the basis of wrong attestation then the<br />
action can be taken against the attestator under Indian Penal Code.
ATTESTION<br />
I certify that Shri/Km./Smt. … … … … … … … … … … … … … … … … …<br />
… .son of/daughter of/wife of … … … … … … … … … … … … … … … … … .<br />
is known to me for the last … … … … … … … … years and he/she belongs to …<br />
… … … … … … … caste and he/she was born at … … … … … … … … … …<br />
… … (place of birth). I also certify personally that the facts given in this form are<br />
correct.<br />
Signature of the Attestator<br />
Name of Attestator (in BLOCK Letters)_________________________<br />
Office Address with Tel no. :______________________________________<br />
Full Residential Address:______________________________________.<br />
______________________________________________________<br />
The above attestation can be done by any of the following officers:-<br />
1. Member of Parliament/MLA/Councillor<br />
2. Gazetted Officer of <strong>Delhi</strong> Govt. /Central Government.<br />
3. Police Officer not below the rank of D.S.P.
List of supporting documents - (Maximum time limit – 60 days)<br />
• Completed application form duly attested by MP/ MLA//Councillor/Gazetted officer.<br />
• AADHAR No., if AADHAR No. is not available, provide the AADHAR Enrolment No. and any<br />
one of the identity proof PAN / PASSPORT / Driving Licence / Voters Card / Identity Card.<br />
The name of the applicant on the AADHAR card should match with the Name of the<br />
Applicant.<br />
• The photograph of the applicant will be captured through web camera at the time of<br />
submission of application or at the time of verification. The Photograph of the applicant<br />
should match with photo of the applicant on the AADHAAR.<br />
• A copy of SC/ST certificate of father, brother, sister or of his/her blood relative from paternal<br />
side.<br />
• Affidavit in case of SC/ST certificate issued from outside <strong>Delhi</strong> in prescribed Performa<br />
attested by executive magistrate (Affidavit from the major if the children are below the 18<br />
years.)<br />
• If certificate of father, brother, sister or of his/her blood relative from paternal side is not<br />
available, two attestations by MP/MLA and Gazetted Officers, declaring the caste of<br />
applicant.<br />
• Supporting document for the present residential proof like Voters Card, Electricity Bill, Water<br />
Bill, Telephone Bill etc.<br />
• Proof of Date of Birth (Birth certificate, School certificate or passport)<br />
• The migrants SC members whose caste are listed in SC list of <strong>Delhi</strong> should be issued caste<br />
certificate as original resident of <strong>Delhi</strong> if any of the following<br />
o Birth <strong>Certificate</strong> (born in <strong>Delhi</strong>.)<br />
o Matriculation <strong>Certificate</strong> (studied in <strong>Delhi</strong>)<br />
Note: All supporting documents must be attested by MPs/MLAs and Gazetted officer.