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[Rule No.5(4)]
FORM OF CASTE CERTIFICATE FOR S.C. & S.T.
1. This is to certify that Shri.Devanand Son / Daughter of Budha Bhil Village/
Town Chinchkhed Prabo Tal. Bodwad Dist. Jalgaon of the State of Maharashtra belongs to
the Bhil Caste/Tribe which is recognized as a Scheduled Caste / Scheduled Tribe at Sr.No.
0. under-
The Constitution Scheduled Castes! "rder# 1$%&
The Constitution Scheduled Tribes! "rder# 1$%&
The Constitution Scheduled Castes! 'nion Territories! "rder# 1$%1
The Constitution Scheduled Tribes! 'nion Territories! "rder# 1$%1
()s a*ended by Constitution Caste and Scheduled Castes and Scheduled Tribes +ists ,odification! "rder 1$%-. The
.o*bay /ecognisation )ct. 1$%-#the State of 0i*achal 1radesh )ct# 1$2-# the 3orth 4astern )reas /ecorganisation!
)ct. 1$21 and the Scheduled Castes# Scheduled Tribes "rders )*end*ent! )ct# 1$2-5
The Constitution 6a**u 7 8ash*ir! SC04D'+4D C)ST4! order# 1$%-
The Constitution )nda*an and 3icobar 9slands:! SC04D'+4D T/9.4S! order# 1$%$ as a*ended by the Scheduled
Castes and Scheduled Tribes "rders )*endw*ent! )ct#1$2-.
The Constitution Dadar 7 3agar 0a;eli! SC04D'+4D C)ST4! order# 1$-<.
The Constitution Dadar 7 3agar 0a;eli! SC04D'+4D T/9.4! order# 1$-<.
The Constitution 1andichery! SC04D'+4D C )ST4! order# 1$-=.
The Constitution >oa# Da*an 7 Diu! SC04D'+4D C)ST4 order# 1$-?.
The Constitution >oa# Da*an 7 Diu! SC04D'+4D T/9.4 order# 1$-?.
The Constitution 3agaland! SC04D'+4D T/9.4 order# 1$2&.
The Constitution Si@@i*! SC04D'+4D C)ST4 order# 1$2?.
The Constitution Si@@i*! SC04D'+4D T/9.4 order# 1$2?.
<. )::licable in the Case of the Scheduled Caste / Scheduled Tribes 1ersons who ha;e *igrated fro* one
State/'nion Territory )d*inistration.
This Certificate issued on the basis of the Scheduled Caste / Scheduled Tribes Certificate issued to
Shri/8u*---------------------Aather/,other of Shri/8u*. ------------------ of Village/Town --------------- in
District/Di;ision ------------ of the State/'nion Territory of ------------- who belong to the -------------- Caste/Tribe
which is recognized as a Scheduled Caste/ Scheduled Tribe in the State/'nion Territory ---------------- issued by the
;ide their 3o. -----------# dated - -------------.
B. Shri.Devanand Budha Bhil and his/her fa*ily ordinarily resides! in Vllage/Town
Chinchkhed Prabo Tal. Bodwad Dist. Jalgaon of the State of Maharashtra.
This certi!icate issued on the strength o! "
15 )::licants S.+.C. <5 )::licants Aather S.+.C. B5 )::licants >rand Aather S.+.C.=5 /ationing
card 7 )ffida;it of a::licant.
No.#M$%#S&#ST# #'0()
Place * Bhusawal
Date " # #'0()
3ote The ter* ordinarily resides!used here will ha;e the sa*e *eaning as in section <& of
the re:resentation of the 1eo:le )ct# 1$%&
+,i-a. Bhangare/
Sub Divisional 0!!icer
Bhusawal Division Bhusawal