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FORM 16 [rule 14] FOR STUDENTS EDUCATION De-Notified …

FORM 16 [rule 14] FOR STUDENTS EDUCATION EDUCATION Application Form for verification of Scheduled Caste/Schedule Caste convert to Buddhism/ De-Notified Tribe (Vimukta Jati) /Nomadic Tribe/Other Backward Class/Special Backward Category certificate to be submitted to Divisional Caste certificate Scrutiny Committee. To, Member Secretary and Research Officer, Divisional Caste Scrutiny Committee, Sub: Verification of Scheduled Caste/Scheduled Caste Converts to Buddhism/De- Notified Tribe (Vimukta Jati)/ Nomadic Tribe/Other Backward Class/Special Backward Category Caste certificate (Strike out whichever is not applicable) Sir, I, the undersigned Shri/Smt/Kum.. hereby request to verify my Caste certificate of Scheduled Caste/Scheduled Caste converts to Buddhism/ De-Notified Tribe (Vimukta Jati)/ Nomadic Tribe/Other Backward Class/ Special Backward Category.

School Leaving Certificate/School Register’s Extract. (a-6) Certified Copy of School Leaving Certificate/ Attached Yes/No School Register’s Extract of Grand Father/ Real Elder Uncle/ Real Aunt (From Paternal side) (a-7) Original Affidavit (in Specimen Form-3 and Attached Yes/No ...

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