FORM OF SCHEDULED CASTE/TRIBE CERTIFICATE
This is to certify that Shri/Shrimati*/Kumari*……………………..………………………
son/daughter* of …………………………………………….. village/town* ………………………………
in District/Division* …………………………………………….. of the State/Union Territory*
…………………………………………….. belongs to the ……………………………………………………..
Caste/Tribe which is recognized as a Scheduled Caste/Scheduled Tribe* under:
*The Constitution (Scheduled Castes) Orders, 1950:
*The Constitution (Scheduled Tribes) Order, 1950;
*The Constitution (Scheduled Tribes) (Union Territories) Order, 1950;
*The Constitution (Scheduled Tribes) (Union Territories) Order, 1951:
{as amended by the Scheduled Castes and Scheduled Tribes List (Modification Order, 1956,
the Bombay Recoganisation Act, 1960, the Punjab Recoganisation Act, 1966, the State of
Himachal Pradesh Act, 1970, the North Eastern Areas (Recognisation) Act, 1971 and the
Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976}
*The Constitution (Jammu and Kashmir) Scheduled Order, 1956;
*The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended
by the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976;
*The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962;
* The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962;
*The Constitution (Pondicherry) Scheduled Castes Order, 1964;
* The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1967;
* The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968;
* The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968;
* The Constitution (Nagaland) Scheduled Tribes Order, 1970.
* The Constitution (Sikkim) Scheduled Tribes Order, 1978.
2. Shri/Shrimati*/Kumari*…………………………………………….. and/or* his/her* family
ordinarily reside(s) in village/town* …………………….…………… of ……………………………………
District/Division* of the State/Union Territory* of ……………………………………………...
Signature: ……………………………………………..
Designation: …………………………………………..
(with seal of office)
State/Union Territory
Place: ………………………………
Date: ……………………….………
____________________________________________________________________________________________
* Please delete the words which are not applicable.
Note:
The term “Ordinarily resides” used here will have the same meaning as in Section 20 of the
Representation of the Peoples Act, 1950.
son/daughter* of …………………………………………….. village/town* ………………………………
in District/Division* …………………………………………….. of the State/Union Territory*
…………………………………………….. belongs to the ……………………………………………………..
Caste/Tribe which is recognized as a Scheduled Caste/Scheduled Tribe* under:
*The Constitution (Scheduled Castes) Orders, 1950:
*The Constitution (Scheduled Tribes) Order, 1950;
*The Constitution (Scheduled Tribes) (Union Territories) Order, 1950;
*The Constitution (Scheduled Tribes) (Union Territories) Order, 1951:
{as amended by the Scheduled Castes and Scheduled Tribes List (Modification Order, 1956,
the Bombay Recoganisation Act, 1960, the Punjab Recoganisation Act, 1966, the State of
Himachal Pradesh Act, 1970, the North Eastern Areas (Recognisation) Act, 1971 and the
Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976}
*The Constitution (Jammu and Kashmir) Scheduled Order, 1956;
*The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended
by the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976;
*The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962;
* The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962;
*The Constitution (Pondicherry) Scheduled Castes Order, 1964;
* The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1967;
* The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968;
* The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968;
* The Constitution (Nagaland) Scheduled Tribes Order, 1970.
* The Constitution (Sikkim) Scheduled Tribes Order, 1978.
2. Shri/Shrimati*/Kumari*…………………………………………….. and/or* his/her* family
ordinarily reside(s) in village/town* …………………….…………… of ……………………………………
District/Division* of the State/Union Territory* of ……………………………………………...
Signature: ……………………………………………..
Designation: …………………………………………..
(with seal of office)
State/Union Territory
Place: ………………………………
Date: ……………………….………
____________________________________________________________________________________________
* Please delete the words which are not applicable.
Note:
The term “Ordinarily resides” used here will have the same meaning as in Section 20 of the
Representation of the Peoples Act, 1950.
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