THE FORM OF CASTE CERTIFICATE This is to certify that Shri/Smt./Kumari ............................................................. son/daughter of ...................................................................... of House .................................................................. ......................................... Village/Town in ......................................................................................... Taluk .................................................... District of Kerala State belongs the ........................................................ Caste/ Tribe which is recognised as a Scheduled Caste/Scheduled Tribe under, The Constitution (Scheduled Castes) Order 1950/ The Constitution (Scheduled Tribes) Order, 1950 as amended by the Scheduled Castes and Scheduled Tribes Orders Amendment Act, 1976. (2) Shri/Smt/Kumari .................................................................. and his/her *family ordinarily reside (s) in ..................................................... Village/Town of .......................................................... District of Kerala State. Place: Signature: Date : Name and Designation: (Seal of office) Note -The term ordinarily resides used above will have the same meaning as in Section 20 of the Representation of the Peoples Act, 1950. * Please delete the words which are not applicable. 1
