Form of Caste Certificate
               This is to Certify that claim of Sri/Smt/Kum._____________________________________________
      S/o.D/o.W/o_______________________________________Village/town H No.___________________
      ________________________________________________Taluk ______________________in the dist
      ________________________________________of the state __________________________________
      been verified as per the procedure laid down and he/she belongs to the _______________________
      be/Backward classes under___________________________________________________________
             *  The constitution (Schedule Castes) Order, 1950.
             *  The constitution (Schedule Tribe) Order, 1950.
      G.O Ms. No. 1793 Education date 23-9-70 as amended from time to time,
      ( As amended by the Scheduled Castes and Scheduled Tribe Lists (Modification) order, 1956 the SC & ST
      amended)
      2. Sri/Smt/Kum.____________________________________________and his/her family ordinarily resides
      in village/town H.No. ________________________________________________________________of
      Dist/Divn. _____________________________________of the state of ___________________________
      of place ____________________________________________state_____________________________
Signature of the Gazetted officer
Date :
Designation :
Office Seal :
NAME