Government Order : SWD 132 SAD 97 (1), Dated 08-02-2000

Government Order : Sa Ka E 225 BCA 2002, Dated 30-03-2002

Government Order : SWD 126 BCA Bangalore, Dated 13-02-2003

Form – D
[(See Rule 3A (2)(3)]

This is Certify that Sri. / Smt / Kum

………………………………………………………………
Son / Daughter of …………………………………………ordinarily residing at
………………..
…………………………………of Village/Town * …………………………in
District/Division ………………….………………of State/Union Territory *
………………………belongs to the ………………………………Caste/Tribes* which is
recognized as a Scheduled Caste/Scheduled Tribes* Under:-
• The Constitution (Scheduled Castes) Order, 1950.
• The Constitution (Scheduled Tribes) Order, 1950.
• The Constitution (Scheduled Castes) (Union Territories) Order, 1951.
• The Constitution (Scheduled Tribes) (Union Territories) Order, 1951.
(as amended by the Schedules Caste and Schedules Tribes Lists
(Modification) Order. 1956. The Bombay Reorganisation Act, 1960.
the Punjab Reorganisation Act, 1966, the State of Himachal Pradesh Act, 1970
and the North Eastern Areas (Reorganisation) Act, 1971.
• The Constitution (Jammu and Kashmir) Scheduled Castes Order, 1956.
• The Constitution (Andaman and Nicobar islands) Schedules Tribes Order, 1959.
as amended by the Scheduled Castes and Scheduled Tribes (Amendment) act, 1976.
• The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962.
• The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962.
• The Constitution (Pondicherry) Scheduled Castes Order, 1964.
• The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962.
• The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, 1968.
• The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968.
• The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968.
• The Constitution (Nagaland) Scheduled Tribes Order, 1970.
 /2/

2. Sri. / Smt* / Kum …………………………………………and or* his/her family

ordinarily reside(s) in village / Town …………………………….of……………
………………..
District/Division * of the State/Union Territory of
……………….………..………………………

Signature……………………….

Tahsildar………………………..
Designation
(with seal of Office)
Date: State
Place: …………………….
Union Territory*

• Please delete the words which are not applicable.

NOTE: - The term “Ordinarily resides” used here will have the same meaning as
in section 20 of the Representation of Peoples Act, 1950.

According to the government of India Letter No.BC 12025/27/76-SCT-I, Ministry of

Home affairs, in order to be competent to issue such certificate, therefore, the authority
mentioned in the Government of India (Department of Personnel and Administrative
Reforms)Letter No.13-2-74-EST-(SCT) dated the 5th August 1975, should be the one
concerned with the locality in which the person applying for the certificate had his place or
permanent abode at the time of the Notification of the relevant Presidential Order. Thus the
Revenue Authority of one Taluk would not be competent to issue such a certificate in respect
of persons belonging to another Taluk.

---
 Form – E
(See Rule 3A (2)(3)

CERTIFICATE TO BE ISSUED TO A CANDIDATES BELONGING TO

BACKWARD CLASSES

Certified that Sri. / Smt /

Kumari…………………………………………………………

Son / Daughter / Wife/Husband of Sri / Smt

……………………………………………………..

Resident of

……………………………………………………………………………………….

………………………………………………………………………….……..Village/Town/Ci

ty belongs to sub-Caste ………………………………………………pf Caste (category

) of the Backward Classes.

Place:
Tahsildar
Date:
………………………Taluk
 Government Order : SWD 126 BCA 2002 , Dated 13-02-2003
Government Order : SWD 225 BCA 2000 , Dated 30-03-2002
Government Order : SAKE 132 SAD 97, Dated 08-02-2000

Form – F
(See Rule 3A (2)(3)

INCOME AND CASTE CERTIFICATE TO BE ISSUED TO CANDIDATES

BELONGING TO BACKWARD CLASSES OTHER THAN CATEGORY – 1

Certified that Sri. / Smt / Kum……………………………………………………………………

Son / Daughter / Wife of Sri / Smt………………………………………………………………..

Residing at……………………………………………………………………………………….

……………………………………………………………………………..and his / her parents /

guardian / wife / husband does not some within the purview of creamy layer specified in
Government Order No. SWL 225 BCA 2000, Dated: 30.03.2002.

Either the applicant or his / Her parents / guardian / wife / husband is not Group-A or Group-3
Officer in the service of the Government; or

Does not held an equivalent post in Public Sector undertaking; or

Is not an employee of a Private Industry / Institution and drawing a Salary, which is not less than
that of a Group-B Officer’s pay scale of Rs.6000-11200.

The candidate and his / her father mother / guardian’s Gross Annual Income does not exceed
rupees two lakhs.
 OR
The candidate and his / her father, mother / guardian’s do not hold ten units of Agricultural Land
as specified in the Karnataka Land Reforms Acts, 1961 or holding more than twenty acre of
Plantation land.

Sri. / Smt / Kum………………………………………………………………… Son / Daughter /

Wife / Husband of Sri / Smt………………………………………………………………………..
Belongs to sub-caste………………………………………of Caste…………………………
………………………..which comes under the category…………………………………
(IIA, IIB, IIIA, IIIB) of the Backward Classes, as per G>O. NO.SWD 225 BCA 2000, Dated
30.3.2002.

TAHASILDAR
(name in Capital letter)
………………………Taluk
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