Page 201 - CURAJ Information Handbook for SC ST Cell

................................................... of village/town* .......................................... in District/Division*............................ of the
State/Union Territory*............................ who belongs to the caste/tribe* which is recognised as a

Scheduled Caste/Scheduled Tribe in the State/Union Territory* of ..................................... issued by the
..................................... dated ......................................

% 3. Shri/Shrimati/Kumari*............................................... and/or* his/her* family ordinarily resides in
village/town*............................. of District/Division* of the State/Union Territory* of..............................................

Signature................................................

**Designation............................................

(With Seal of Office)
State/Union Territory*

Place: .....................................
Date: ......................................

* Please delete the words which are not applicable.
@ Please quote specific Presidential Order.
% Delete the paragraph which is not applicable.

NOTE: The term “ordinarily reside (s)” used here will have the same meaning as in Section 20 of
the Representation of the People Act, 1950.

**List of authorities empowered to issue Scheduled Caste/Scheduled Tribe Certificate.

(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/ Additional
Deputy Commissioner/Deputy Collector/1st Class Stipendiary Magistrate/† Sub-Divisional
Magistrate/Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner.
†(not below of the rank of 1st Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officers not below the rank of Tehsildar.
(iv) Sub Divisional Officer of the area where the candidate and/or his/her family normally resides.
(v) Administrator/Secretary to Administrator/Development Officer(Lakshadweep)

Page | 192