Cost : ` 1/-

ANNEXURE - B
APPLICATION FORM FOR CERTIFICATE OF ELIGIBILITY FOR RESERVATION
OF JOBS FOR THE OTHER BACKWARD CLASSES IN CIVIL POSTS AND
SERVICES UNDERCENTRAL GOVT. OF INDIA
Sir,
I request you a CERTIFICATE in respect of Reservation for BACKWARD CLASSES in civil POSTS &
SERVICES under Government of India be granted to me.
I. Given below of the necessary particulars
1. Full name of the Applicant : _________________________________________________________________________
(In Block Letters)
2. Gender : _____________________ 3. Date of Birth : ________________________________
4. Complete Resident Address : _________________________________________________________________________
a) PERMANENT
D.No : __________________ Locality : _______________________ Village : ______________________________
Mandal : _________________________ District : ____________________________ Pincode : ________________
b) PRESENT (Postal Address)
D.No : __________________ Locality : _______________________ Village : ______________________________
Mandal : _________________________ District : ____________________________ Pincode : ________________
5. Religion : ______________________ 6. Caste : __________________________ 7. Sub-Caste : _________________
8. Issued Caste Certificate In Past : YES / NO

9. Education Certificate Contains Caste : YES / NO

10. Occupation Group : ________________________________________________________________________________

11. SERIAL NUMBER of the Caste in the CENTRAL LIST OF OBCs : _________________________________________
12. Name of the Father : _______________________________________________________________________________
13. Name of the Mother : ______________________________________________________________________________
14. Name of the Husband : _____________________________________________________________________________
15. Status of the Parents(S) / Husband : Father/Husband

Mother/wife

a) Constitutional Posts : ___________________________ b) Designation : __________________________________

c) i) Services: CENTRAL / STATE : _________________________
ii) Designation : ______________________________ iii) Scale of Pay, including : _____________________________
Clarification if any : ___________________________ iv) Date of Appointment of Post : ________________________
v) Age of the time of Promotion : _____________________to Class I post (if applicable) : _______________________
(PTO)

II. EMPLOYMENT IN INTERNATIONAL ORGANIDATION E.G., U.N., UNICEF, WHO

i) Name of the Organization : ____________________________________ ii) Designation : ________________________
iii) Period of Service (Indicate Date) : FROM__________________________ TO _____________________________
III. A. DEATH / PERMENT INCAPACITION (OMIT IF NOT APPLICABLE)
i. Date of death / Permanent Incapacitation putting an Officer Out of Service : ________________________________
ii. Details of permanent incapacitation : _______________________________________________________________
B. EMPLOYMENT IN PUBLIC SECTOR UNDERTAKING ETC.,
i) Name of the Organization : __________________________________ ii) Designation : _______________________
iii. Date of appointment to the Post :___________________________________
C. ARMED FORCES INCLUDING PARA MILITARY FORCES
(THIS WILL NOT INCLUDE PERSONS HOLDING CIVIL POSTS)
i. Designation : ____________________________________ ii. Scale of Pay : ________________________________
D. PROFESSIONAL CLASS (OTHER THAN THOSE COVERED IN THE ITEM NOS. B&C AND
THOSE ENGAGED IN TRADE, BUSINESS AND INDUSTRY)
i. Occupation / Profession : ________________________________________________________________________
E. PROPERTY OWNERS:
I. Agricultural land holding owned by mother / father and minor Children : ___________________________________
ii. Location : ___________________________________ iii. Size of holding : ________________________________
iv. a) IRRIGATED (TYPE OF IRRIGATION LAND)
I)
ii)
iii)
b) UNIRRIGATED
iv) Percentage of Irrigated Land holding to statutory ceiling limit : _______________________________________
under State Land Ceiling Land
v) If land holding is both irrigated / unirrigated total irrigated land : ______________________________________
holding on the basis of conversion formula in State Land Ceiling
vi) Percentage of total irrigated land holding to : ______________________________________________________
statutory ceiling limit as per (vi)
TO BE CERTIFIED DISTRCT REVENUE OFFICER NOT LOWER THAN
MANDAL REVENUE OFFCIER / TAHSILDAR
II. PLANTATION
i.

Crops / Fruits : _________________________ ii. Location : _________________________________________

iii. Area of Plantation : __________________________________________

F. III. VACANT LAND AND / OR BUILDING IN URBAN AREA OF URBAN AGGLEMERATION

i. Location of Property : _____________________________ ii. Details of Property : _________________________
iii. Use to which it is put : _____________________________
G. INCOME / WEALTH
i. Annual Income from all Source (Family Income) : _____________________________________________________
(Excluding Salaries and Income from Agrl. Land)

ii. Whether Tax Paid : YES / NO

iii. Whether covered in Wealth Tax Act. (Yes / No) (If so furnish details) : _____________________________________
16. Family members consisting : _________________________________________________________________________
17. Purpose of Caste Certificate : ________________________________________________________________________
18. Ration Card Number : ________________________________ 19. Aadhar Number : ____________________________
20 Any other Information : _____________________________________________________________________________
21.I certify that the above said particulars are true to the best of my knowledge and belief and that I do not belongs to
CREAMY LAYER of OBCs and eligible to be considered for posts reserved for OBCs. In the event of any information
being found false or incorrect of ineligibility being detected before of after the selection. I understand that my
candidature appointment is liable to be cancelled and I shall be liable to such further action as may be provided under
law /or rules.

Yours faithfully,

Place:

Signature of the Candidate

Dated:

Procedure (following to be enclosed)

Contact Details

1)
2)
3)
4)

Land Line Number:

Mobile Number:
E- Mail ID:

Application *
Ration Card/Aadhar Card/EPIC Card #
Applicant Father/Mother property particulars #
Applicant Father/Mother Employment
Particulars/Income Tax returns (for professionals) *

(*-mandatory #-any one of them)

SERVICES OFFERED
Sl. No.

Service

Service Level

Service Charges (`)

Extract of Adangal / Pahani

15 Minutes *

25/-

Extract of ROR 1B

15 Minutes *

25/-

Copy of FMB

15 Minutes *

25/-

Copy of Village Map

5 Days

35/-

F-Line Petitions

30 Days

35/-

Sub-Division of Lands

30 Days

35/-

Mutation of Entries in Revenue Records

45 Days

35/-

Income Certificate

1st time - 7 days 2nd time &

thereafter - 15 minutes

35/-

Residence Certificate

1st time - 7 days 2nd time &

thereafter - 15 minutes

35/-

10

Integrated Certificate
(Caste-Nativity-Date of Birth)

1st time - 30 days 2nd time &

thereafter - 15 minutes

35/-

11

OBC Caste Certificate

1st time - 30 days 2nd time &

thereafter - 15 minutes

35/-

12

EBC Certificate

1st time - 7 days 2nd time &

thereafter - 15 minutes

35/-

13

Agricultural Income Certificate

1st time - 7 days 2nd time &

thereafter - 15 minutes

35/-

14

No Earning Member Certificate

1st time - 7 days 2nd time &

thereafter - 15 minutes

35/-

15

Family Member Certificate

(Social Security Schemes &
Govt. Employees / Pensioners)

1st time - 7 days 2nd time &

thereafter - 15 minutes

35/-

16

Issue of Encumbrance Certificate

Same day, if submitted by 2 pm

25/-

17

Certified Copy of Registration Document

15 minutes

25/-

18

Money Lending License

Fresh - 45 days Renewal - 30 days

35/-

19

Allopathic Medical Care Registration

90 Days

35/-

20

Apathbandhu Scheme

10 Days

35/-

21

NFBS Application

1 Week

35/-

22

No Objection Certificate (Lands)

30 Days

35/-

23

Pawn Broker License

Fresh - 45 days Renewal - 30 days

35/-

24

School Registration

1 Week

35/-

25

Birth Certificate - GHMC

15 Mins. (Category-A)

25/- per transaction + statutory charges

5/- per additional copy

26

Death Certificate - GHMC

15 Mins. (Category-A)

25/- per transaction + statutory charges

5/- per additional copy

27

Birth Certificate Corrections - GHMC

6 Working Days

60/- + 25/- per copy of certificate

28

Death Certificate Corrections - GHMC

6 Working Days

60/- + 25/- per copy of certificate

10/- + 25/- per copy of certificate
(after one year)

29

Child Name Inclusion - GHMC

6 Working Days
(within one year)

25/- per copy of certificate

30

Non Availability Certificate Birth - GHMC

3 Working Days

25/- per copy of certificate

NOTE :
1. Postal charges extra.
2. *Subject to availability of online digital records, otherwise the request will be processed within 7 days.
3. Printing of additional pages at ` 2/- per page.

1100

www.meeseva.gov.in