Form I Application Form for being a member of the Schedule Caste To The Competent Authority, __________________________, Sir, I request that a certificate of being a member of the Schedule Caste is being issued in my favor. The grounds of my claim and other particulars are given as below : 1. Name of the Applicant __________________________________________________ 2. Father's Name ___________________________________________________ 3. Place of Residence ___________________________________________________ i. Village/ Mohalla ___________________________________________________ ii. Tehsil ____________________________________________________ iii. District 4. Whether the applicant is a permanent residence of the state _____________________________________________ 5. The applicant belong to the Caste of the Schedule Caste ______________________________________________ 6. Date of Submission _____________________________________________ I solemnly declare that above entries are true to my knowledge. Signature of the Applicant For Use in Office or Competent Authority) Application received on ______________ and entred in the Register under No. ______________ Competent Authority With Seal
