ANNEXURE-I

The Form of the certificate to be produced by Scheduled Castes and Scheduled Tribes candidates applying for appointment to posts under the Government of India

 This is to certify that Shri/Shrimati/Mumari*__________________________ son/daughter*of __________________________of village/Twon*___________________ in District/ Division* Shri ___________________________ of State/Union Territory* _______________________belongs to the__________________________ Caste/Tribe* which is recognised as a Scheduled Caste/Scheduled Tribe* 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 Scheduled Castes and Scheduled Tribes Lists (Modification) Order, 1956, the Bombay Recognisation Act, 1960, the Punjab Recognisation Act,1966, the State of Himachal Pradesh Act, 1970 and the North Estern Areas (Recognisation) Act, 1971 and the Scheduled Castes and Scheduled Tribes Orders,(Amendment) Act, 1976]
The Constitution (Jammu & Kasmir Scheduled Castes Order, 1956*
The Constitution (Andaman and Nicobar Islands )Scheduled Tribes Order, 1959* as amended by the Scheduled Castes and Scheduled Tribes Order (Amendment) Act, 1976*
The Constitution(Dadara and Nagar Haveli) Scheuled Castes Order, 1962 The Conistitution(Dadra and Nagar Haveli) Scheduled Tribes, Order, 1962*
TheConistitution(Pondicherry) Scheduled Castes Orders,1964*
The Conistitution(Scheduled Tribes)(Uttar Pradesh) Order, 1967*
TheConistiution(Goa, Daman and Diu) Scheduled Castes Order,1968*
TheConistiution(Goa, Daman and Diu) Scheduled Tribes Order,1968*
The Constitution(Nagaland) Scheduled Tribes Order,1970*
TheConistitution(Sikkim) Scheduled Castes Order,1978*
The Conistitution(Sikkim) Scheduled Tribes Order,1978*

2.        Shri/Shrimati/Kmuari*____________________and/or his/her* family, reside(s) in village/town* ___________________ of* _____________________ Dstrict/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.

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.
**Officers competent to issue Caste/Tribe certificates :

i.       District Magistrate/Additional District Magistrate/Collector/Deputy Commission/Additional Deputy Commissioner/Deputy Collector/Ist Class Stipendiary Magistrate/City Magistrate/Sub-Divisional Magistrate/Taluka Magistrate/Excutive Magistrate/Extra Assistant Commissioner.
* (not below the rank of Ist class Stipendary 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 family normally reside(s). Administrator/Secretary to Administrator/Development Officer(Lakshdweep).