Minds Are Open Only When the Hearts Are Open

APPLICATION FORM SCHEDULED CASTE CLASS / SCHEDULE TRIBE CLASS BACKWARD CLASS FOR PROFORMA To, ______________ Mandal, Hyderabad, A.P. Sir,
1. Name of the Applicant (In Block Letters & Full) : ______________________________________________

Affix 2 Rupees Court Fee Stamp

2. Father’s Name

:

______________________________________________

3. Sex

:

______________________________________________

4. Native Place (Origin District) : ______________________________________________

5. Present Address H.No. 6. Caste Claimed S.C./ S.T. /B.C. /O.C.

: :

______________________________________________ ______________________________________________

7. List of Documents enclosed T.C. from the recognized School or College of Caste Certificate earlier if any To the family member

:

______________________________________________

8. Origin of Present Age Affidavit duly enclosed

:

______________________________________________

9. Copy of the Ration Card

:

______________________________________________

10. Two different Gazetted Officer’s Certificate of State Govt.

:

______________________________________________ DECLARATION

I declare that the information furnished by me in this application is true and correct and that it is found to be untrue and incorrect, I will be liable for prosecution for furnishing false information under Section 199 and 200 of I.P.C.
SIGNATURE OF THE APPLICANT Date: / /20 ( )

Place: Hyderabad, A.P Certificates enclosed: ( ) 1) 2) 3) 4) 5) 6) 7) Two different State Govt. Gazetted Officer Certificate. Affidavit with Notary on Rs. 10/- Bond Paper. T.C, Bonafide & S.S.C Memo Xerox with Attested by the State Govt. Gazetted Officer. Ration card with Attested by the State Govt. Gazetted Officer. Photo Identity Card issued by the Election Commission or Electorate rolls from Municipality. Caste Certificate issued to any of the family members Xerox attested by the State Govt. Gazetted Officer.