Application Form for a Certificate for Eligibility for Reservation of Jobs for Other Backward Classes in Civil Posts and Services - Tamil Nadu India

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APPLICATION FORM FOR A CERTIFICATE FOR ELIGIBILITY FOR
RESERVATION OF JOBS FOR OTHER BACKWARD CLASSES IN CIVIL POSTS AND
SERVICES UNDER GOVERNMENT OF INDIA
TO
Sir,
I request that a certificate in respect of reservation for other backward classes in civil post and
services under Government of India be granted to me.
I) Given below the necessary particulars:
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. Occupational group
:
8. Serial Number of the caste in
the Central list of OBCs
:
9. Name of Father
:
10.Name of Mother
:
APPLICATION FORM FOR A CERTIFICATE FOR ELIGIBILITY FOR
RESERVATION OF JOBS FOR OTHER BACKWARD CLASSES IN CIVIL POSTS AND
SERVICES UNDER GOVERNMENT OF INDIA
TO
Sir,
I request that a certificate in respect of reservation for other backward classes in civil post and
services under Government of India be granted to me.
I) Given below the necessary particulars:
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. Occupational group
:
8. Serial Number of the caste in
the Central list of OBCs
:
9. Name of Father
:
10.Name of Mother
:
11.Name of Husband
:
12.Status of parent(s) /Husband
:
Father
Mother
Husband
A) Constitutional posts
I) Designation
B) Government Services
i) Service( central/state)
ii) Designation
iii) Scale of pay, including
clasification if any
iv) Date of appointment to the post
v) Age at the time of promotion to
class I post (if applicable)
II) Employment in International Organization. e.g.UN,UNICEF, WHO
i) Name of organization
:
ii) Designation
:
iii) Period of service(indicate
from
to
:
III) Death/Permanent incapacitation(omit if not applicable)
i) Date of death/permanent in
capacitation putting an officer
out of service
ii) Date of permanent incapacitation
:
C. Employment in public sector undertaking etc.,
i) Name of organization
:
ii) Designation
:
iii) Date of appointment to the post :
D. Armed forces including para-military forces:
(this will not include persons holding civil posts)
i) Designation
:
ii) Scale of pay
:
E. Professional class (other than those covered in item Nos.
B&C and those engaged in trade, business and industry.
i) Occupation/Profession
:
F. Property Owners:
I) Agricultural land holdings(owned by mother,father and
minor children)
i) Location
:
ii) Size of holding
:
iii) a) Irrigatied (type of irrigation land)
i)
ii)
iii)
b) Unirrigated
iv) Percentage of irrigated land
holding to statutory ceiling
limit under state land ceiling laws
v) If land holding in both irrigated/un-irrigated
total irrigated land holding on the basis of conversion
formulate in state land ceiling laws.
vi) If land holding to statuory ceiling limit
as per (iv)
II) Plantation:
i) Crops/Fruit
:
ii) Location
:
iii) Area of plantatio/or buildings in
urban areas or urban agglomeration :
f.(III) Vacant land and/or buildings
in urban areas or urban agglomeration
:
i) Location of property
:
ii) Details of property
:
iii) Use to which it is put
:
g) Income/Wealth
:
i) Annual family income from all sources
(excluding salaries and income from
agricultural land)
:
ii) Whether tax payer (yes/No) (if yes
copy of the last three year return
be furnished)
iii) Whether covered in wealth tax act (yes/no
if so furnish details)
h) Any other remarks
:
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 creamy layer of OBCs and an eligible to be considered for post reserved for
OBCs. In the event of any information being found false or incorrect or ineligibility being detected
before or after the selection, I understand that my candidature appointment is liable to be
cancelled and I shall be liable to such further action as may be provided under the law and/or
rules.
Place:
Yours faithfully,
Date:
(Signature of the candidate)
OTHER BACKWARD CLASS CERTIFICATE
THIS IS TO CERTIFY THAT SELVAN / SELVI
S/o, D/o
OF VILLAGE
______
DISTRICT / DIVISION _______________________IN THE TAMILNADU STATE BELONGS TO
COMMUNITY WHICH IS RECOGNISED AS A BACKWARD
CLASS UNDER THE GOVERNMENT OF INDIA, MINISTRY OF WELFARE RESOLUTION NO.
12011/68/93-BCC (C) DATED 10TH SEPTEMBER, 1993 PUBLISHED IN THE GAZETTE OF
INDIA EXTRAORDINARY PART-I SECTION I, DATED 13TH SEPTEMBER 1993.
SELVAN / SELVI
______ AND / OR HIS FAMILY ORDINARILY
RESIDES IN THE _______________________________________ DISTRICT/DIVISION OF THE
TAMILNADU STATE.
THIS IS ALSO TO CERTIFY THAT HE/SHE DOES NOT BELONG TO THE PERSONS /
SECTIONS (CREAMY LAYER) MENTIONED IN COLUMN 3 OF THE SCHEDULE TO THE
GOVERNMENT OF INDIA, DEPARTMENT OF PERSONNEL AND TRAINING O.M. No. 36012
/22 /93-Estt (SCT) DATED 08/09/1993.
DATE
SEAL
SIGNATURE
DESIGNATION

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