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prospectus download - Uckkr.org

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Annexure-XVI<br />

ECONOMICALLY BACKWARD PERSONS IN THE GENERAL CASTE CATEGORY<br />

Photo of<br />

Applicant to be<br />

Attested by the<br />

Issuing authority<br />

ph<br />

This is to certified that Shri/Smt./Kumari______________son/daughter of Shri_______________resident of<br />

Village/Town ____________________________ Tehsil______________ District _________________ of the<br />

State/Union Territory ______________ Caste _______________belongs to the category of Economically<br />

Backward Persons in the General Caste Category.<br />

This certificate has been issued in accordance with the Haryana Govt. Notification No.60 SW(1)-2013 dated<br />

23.01.2013 issued by Welfare of SC & BC Department and letter No.22/10/2013-1GS-III dated 28.2.2013 and<br />

other instructions issued in the matter from time to time.<br />

Sr. No. ……………….<br />

Place …………………<br />

Dated …………………<br />

Signature with seal of issuing Authority<br />

Full Name …………………………….<br />

Designation …………………………...<br />

Address with Telephone No. with code …………….<br />

Issuing Authority : Tehsildar-cum-Executive Magistrate<br />

Naib Tehsildar-cum-Executive Magistrate<br />

Head of Department in case of Govt. employees<br />

….………………………………………………………………………………………..……………..…………<br />

The affidavit should be of the month of May 2014 or later.<br />

56

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