FORM OF CERTIFICATE PRESCRIBED Form of Certificate as prescribed in M.M.A., O.M.No.42/21/49-N.G.S.,dated 28-1-1952. As revised in Deptt . of per & A.R.,LetterNo,.36012/6/76-Estt(SCT) Dated19-10-1977 SCHEDULED CASTE/SCHEDULED TRIBE CERTIFICATE This is to certify that Shri Shrimati Kumari Son Daughter of Of Village Town in District Division Of the State Union Territory belongs to the Caste Tribe which is recognized as a under: The Constitution ( Scheduled Caste ) Order.,1950. The Constitution(Scheduled Tribes) Order,1950. The Constitution(Scheduled Caste) (Union Territories)Order,1951. The Constitution( Scheduled Tribes) (Union Territories)Order,1951 (As amended by the scheduled Castes and Scheduled tribes lists (Modification Order, 1956, the Bombay Reorganisation Act,1960,the Punjab Reorganisation Act, 1966, the Sate of Himachal Pradesh Act,1970, the North -Eastern Areas (Reorganisation ) Act, 1971 and the Scheduled Castes and Scheduled Tribes orders ( Amendment ) Act.1976, The Constitution( Jamu and Kashmir) Scheduled Castes Order,1956 The Constitution( Andaman and Nicober 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 Order1962 The Constitution (Pondicharry) Scheduled Castes Order,1964. The Constitution Scheduled Tribes (Uttar Pradesh) Order, 1967. The Constitution (Goa , Daman and Diu) Scheduled Tries order,196 The Constitution(Nagaland) Scheduled Tribes Order,1970. As per part XI of the Constitution ( Scheduled Castes) Order,1950 is amended by the Scheduled Castes and Scheduled Tribe Order1976. 2. Shri Shrimati Kumari and or his her family ordinarily reside(s) in Village Town of District Division of the State Union Territory of Place: Date: Signature: Designation: (With Seal of the Office) http://imphalwest.nic.in