OFFICE OF SUB DIVISIONAL OFFICER, Amravati.

MRC-81/Kani Mirzapur/                          /2012-2013.
Common Services Centre, NANDGAON K NR T.

ANNEXURE - 'A'

Form of Certificate to be produced by Other Backward Classes, Vimukta Jati (A), Nomadic Tribes (B,C,D) and Special Backward Category and its synonyms belonging to the State of Maharashtra.

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1.Copy of Kotwal Book of Grandfather
2.Copy of Ration Card
3.Copy of School Leaving Certificate
4.Application submitted by the Applicant.
5.Copy of School Leaving Certificate of Father.
6.Affidavit submitted by the Applicant.

CASTE CERTIFICATE

              This is to certify that Shri Amit Rajendra Sawade Son/Daughter of Shri. Rajendra Pralhadrao Sawade of village Kani Mirzapur, Taluka Nandgaon Khandeshwar , in District Amravati of the State of Maharashtra belongs to the Kunbi (83) Caste which is recognized as a Other Backward Class under the Government Resolution Department No:- CBC 1467/M Dt. 13/10/1967 as amended from time to time.

              Shri Amit Rajendra Sawade and His/Her family ordinarily resides(s) in village Kani Mirzapur, Taluka Nandgaon Khandeshwar of District Amravati of the State of Maharashtra.

SR.No. Place : Amravati.
Date :
	Sub Divisional Officer.
	Amravati.

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Please delete the words which are not applicable.
Please quote the name of department and specific number and date of Resolution under which the caste/community/tribe has been recognized as O.B.C.,V.J., N.T., S.B.C. by the Government of Maharashtra.
N.B. - The term 'Ordinarily' used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950.