Page 9 of 11
Annexure ‘A’
FORM OF CASTE CERTIFICATE FOR SC/ST CANDIDATES
This is to certify that Shri/Smt./Kum.* ……………. Son/Daughter* of ………….. of village /town*
……………District/Division* ……………………… of state/Union Territory* …………… belongs to the ………
Caste/Tribe * which is recognized as Scheduled Caste/Schedule Tribe* under.
The Constitution (Scheduled Caste/Scheduled Tribes) order , 1950
The Constitution (Scheduled Caste/Tribe) (Union Territories) order , 1951 ( as amended by the Schedule Caste and
Scheduled Tribes Lists Modification) Order 1956 the Bombay Reorganization Act 1960, the Punjab Reorganization Act, 1966,
the State of Himachal Pradesh Act, 1970, the North Eastern Areas Reorganization Act 1971 and the Scheduled Tribes Order (
Amendment Act, 1976.
The Constitution (Jammu & Kashmir) Scheduled Caste order , 1956
The Constitution (Jammu & Kashmir) Scheduled Tribes order , 1956
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes order , 1962
The Constitution (Dadra and Nagar Haveli) Scheduled Caste order , 1962
The Constitution (Dadra and Nagar Haveli) Scheduled Tribes order , 1962
The Constitution (Pondicherry) Scheduled Caste order , 1964
The Constitution Scheduled Tribes (Uttar Pradesh) order , 1967
The Constitution (Goa, Daman and Diu) Scheduled Caste order , 1968
The Constitution (Goa, Daman and Diu) Scheduled Tribes order , 1968
The Constitution (Nagaland) Scheduled Tribes order , 1970
The Constitution (Sikkim) Scheduled Caste order , 1978
The Constitution (Sikkim) Scheduled Tribes order , 1978
The Constitution (Jammu & Kashmir) Scheduled Tribes order, 1989
The Constitution (Scheduled Cast) order (Amendment) Act. 1990
The Constitution (Scheduled Cast) order (Amendment) Act. 1991
The Constitution (Scheduled Cast) order (2nd Amendment) Act. 1991
The Constitution (Scheduled Tribes) order (Amendment) Act. 1996
The Constitution (Scheduled Cast) order (Amendment) Act. 2002.
The Constitution (Scheduled Cast) order (Second Amendment) Act. 2002.
The Scheduled Cast and Schedule Tribes order (Amendment) Act. 2002.
2. Application in the case of Scheduled Caste/Scheduled Tribe Persons who have migrated from one
State/Union Territory Administration.
This certificate is issued on the basis of Scheduled Caste/Scheduled Tribe certificate issued to
Shri/Smt/Kum*..........................................father/Mother*…………………………… of Shri/Smt./Kum.........................
of Village/Town* ……………………………….. In District/Division*………………..................... of State/Union
Territory*……………………….........who belongs to the…………………........... Caste/Tribe* which is recognized
as a Scheduled Caste/Scheduled Tribe in State/Union Territory*issued by the...........................(name of
prescribed authority) vide their No............dated.........
3. Shri/Smt/Kum*.........................................and of his/her* family ordinarily reside(s) in
village/town*..........................of………………................District/Division* of State/Union Territory
of..............................
Place:................. Signature: …………………………………..
Date: …………… Designation ……………………………….
(with seal of office)
State/Union Territory .............................
Please delete the words which are not applicable.Please quote specific presidential offer. Please delete
the Paragraph which is not applicable.
Note: (a) The term ‘Ordinarily reside’(s) used will have the same meaning as in Section 20 of the
Representation of the Peoples Act, 1950.
The following officers are authorized to issue cast certificates:
1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy
Commissioner/Deputy Collector/1st Class Stipendary Magistrate/Sub Divisional
Magistrate/TalukaMagistrate/ExecutiveMagistrate/Extra Assistant Commissioner.
2. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
3. Revenue Officer not below the rank of Tehsildar.
4. Sub-Divisional Officer of the area where the candidate and/or his family normally resides.
5. Certificates issued by Gazetted Officers of the Central or of a State Government countersigned by the District Magistrate
concerned.
6. Administrator/Secretary to Administrator (Laccadive, Minicoy and Amindivi Islands)