APPLICATION FORM FOR A CERTIFICATE FOR ELIGIBILITY FOR RESERVATION OF JOBS FOR OTHER BACKWARD CLASSES IN CIVIL POSTS AND SERVICES UNDER GOVERNMENT OF INDIA. (This from however, should be used as a model additional items, if necessary may be incorporated to suit to the local situation in the form) Sir, In request that a certificate in respect of reservation for Other Backward Classes in Civil Posts and service under Government of India be granted to me. 1. Give below the necessary applicant : 1. Full name of the applicant : (In block letters) 2. Date of birth : 3. Complete residential address : a) Present b) Permanent 4. Religion 5. Caste 6. Sub-Caste 7. Occupation Group 8. Serial Number of the Caste in the Central List of OBCs. 9. Name of Father 10. Name of Husband 11. Name of Mother 12. Status of parents (s)/Husband : Father Mother Husband (c) Constitutional Posts (i) Designation (ii) Government Services (i) Service (Central/State) (ii) Designation (i) Scale of pay, including classification, if any, Rs. Date of appointment to the post : Age at the time of promoting to Class - 1 : (if applicable) Employment in international organisation. e.g. UN, UNICEF, WHO. Name of the Organisation : (ii)Designation : (iii) Period of Service (indicated date from ______________________ to ______________________ (iv)Death/Permanent Incapacitation (Omit if not applicable). (v) Date of death/permanent Incapacitation putting on officer our of service. (vi)Details of permanent incapacitation. (C)Employment in Public undertaking, etc. (i)Name of Organisation : (ii)Designation : (iii)Date of appointment to the post : (D)Armed Force including para-military forces :- (i)Designation :- (ii)Scale of Pay :- (E)Professional class (Other than those covered in Item No. D&G and those engaged in Business and Industry :- (i)Occupation/Profession :- (F)Agricultural land holding owned by mother, father and minor children. (i)Location :-(ii)Size of the holding :- (iii) (a)irrigated type of irrigated land. (i) (ii) (iii) (b)Unirrigated To be certified by District Revenue Officer not lower than the rank of Tehsildar. (G)Plantation : (i)Crops/Fruit (ii)Location (iii)Areas of plantation. (iv)percentage of irrigated land holding to statutor ceiling limit under State Land ceiling Act. (v)if land holding irrigated penirrigated total irrigate land holdings on the ba- sis of coneersion formul in State Land Ceiling Law. (iii)percentage of total irrigated land holding as tutory ceiling limit as per (iv) (H)Vacant Land and/or building in urban areas or urban agulemoration (i)Location of property : (ii)Details of property : (iii)Use to which it is put : I. Income/Wealth (i)Annual Family from all sources (excluding salaries and income from Agricultural land). (ii)Whether Tax payer (Yes/No) (iii)Whether covered in wealth Tax Act (Yes/No) (J)Any other remarks. (E) (i) Name of Father Office in which Scale of Pay Post held Total applicant Mother/all bro- employed ther and sisters of the applicant (I) Income/Wealth 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. E. II.Whether the cnadidate possess any immovable property in Meghalaya, outside Meghalaya, if so, please furnish detail alongwith present market value. E. III.Whether the candidate's parents posses any immovable property in Meghalaya, if so, please furnish details alongwith present market value. E. IV.If the candidate of his/her parents posses any immovable like Car, Truck, etc, if so, plesase furnish details of their mode of use alongwith the present market value. E. V.Present occupation of the cnadidate with annual income. (vi) I Certify that the above said particulars are true to the best of my knowledge and belief and that I do not belong to the greamy Loyer of OBCs and eligible for considered for posts reserved for OBCs. In the event of any information being false or correct, or ineligibility being detached before or after the selection I understand that my candidature/appointment is liable to be cancelled and penalties liable to be such further action as may be provided under the Law and/or Rules. Place : Yours faithfully, Date : Signature of the candidate Declaration by the Gazetted Officer :- Certified that Shri/Smti ................ son of daughter of Shri/Smti .............. Resident of .................... Belongs to ..................... Community which is recognised as Other Backward classes. 2.Further to certify that the total annual income of all the members of the family from all sources of Shri/Smti............ (applicant) is Rs........... (Rupees in words) .............. Signature with date :- Designation : Official Seal :
