Roll Numbers of candidates shortlisted for Interview

Transcription

1 Reserve Bank of India Services Board (October 30, 2014) Recruitment of Officers in Grade B (General) (DR) for which Phase II Written examination was held on September 13 & 14, 2014 Roll Numbers of candidates shortlisted for Interview NOTE: Mark list & category wise cut off for the above examination and final selection will be displayed on website after completion of the selection process and declaration of final results of the recruitment. 1. The interview call letters to all these shortlisted candidates indicating dates and venue of the interview will be sent through (as registered in the application) during next one to two weeks. 2. All the shortlisted candidates are advised to take print out of interview letter through their E mail ID and bring it (hard copy) on the day of interview alongwith ORIGINAL certificates. 3. All these shortlisted candidates are advised to send the photocopy of the certificates (one set of copies) in support of their Date of Birth, Academic Qualifications (Mark sheets of all semesters/years and Degree certificates), Caste Status (if SC/ST/OBC), Disability certificate (if Persons with Disability PWD) and No Objection Certificate from present employer (wherever applicable). 4. As regards academic qualification, if instead of percentage of marks, Aggregate Grade Points (i.e. CGPA/OGPA/CPI etc.) are allotted, then the candidate must forward the criteria for conversion as defined by the University/Institute. The conversion criterion must be printed on the mark sheet or the candidate must obtain a certified copy from competent authority of the University/Institute and forward the same to us. If they fail to do so, then the conversion criteria as mentioned at para 2 (b) of the recruitment advertisement no. 5A/ will be applied. 5. If the shortlisted candidate has taken any benefit of age relaxation, he/she should submit the relevant certificate. 6. Shortlisted Staff candidates should submit their documents through the HRMD/Staff section of respective Regional Office/COD. 7. All these shortlisted candidates are also requested to take print out of the relevant proformae mentioned below, duly complete them and send alongwith copy of above mentioned certificates to The General Manager, Reserve Bank of India Services Board, Reserve Bank of India Building, 3rd floor, Opposite Mumbai Central Railway Station, Byculla, Mumbai by Courier/Speed Post so that it reaches the Board office within seven days of the date of declaration of the result on the website. (i) All Candidates 5 copies of ATTESTATION FORM (all in original) and 6 copies of BIO DATA with prescribed sized, signed photographs affixed.

2 (ii) OBC candidates In addition to (i) above, OBC DECLARATION in original and a copy of latest OBC CASTE CERTIFICATE (issued on or after ) as per the prescribed format. (iii) SC/ST candidates In addition to (i) above, latest SC ST CASTE CERTIFICATE as per the prescribed format. (iv) PWD candidates In addition to (i) [and (ii)/(iii) if applicable] above, disability certificate in the prescribed format issued by the Competent Authority. The Candidates who have availed the facility of a scribe (other than the Visually Impaired candidates) will have to produce a medical certificate from an authorised Govt. of India/State Govt. Department/Hospital, to the effect that the candidate has physical limitation to write including that of speed. This certificate will be required in addition to his/her disability certificate. The medical certificate about physical limitation to write, including that of speed, should be dated prior to the date of on line/written exam/test. Disclaimer: Though utmost care has been taken while preparing the list of successful candidates, the Board reserves the right to rectify inadvertent errors, if any.

3 RESERVE BANK OF INDIA SERVICES BOARD Date:30-OCT-2014 OFFICER'S IN GR B (GEN)-DR-BY-2014 (PHASE-II) Result List AHMEDABAD BANGALORE BHOPAL BHUBANESWAR CHANDIGARH CHENNAI AM/Manager AGM General Manager Page 1 of 4

4 RESERVE BANK OF INDIA SERVICES BOARD Date:30-OCT-2014 OFFICER'S IN GR B (GEN)-DR-BY-2014 (PHASE-II) Result List GUWAHATI HYDERABAD JAIPUR JAMMU KANPUR KOCHI KOLKATA AM/Manager AGM General Manager Page 2 of 4

5 RESERVE BANK OF INDIA SERVICES BOARD Date:30-OCT-2014 OFFICER'S IN GR B (GEN)-DR-BY-2014 (PHASE-II) Result List LUCKNOW MUMBAI NAGPUR NEW DELHI AM/Manager AGM General Manager Page 3 of 4

6 RESERVE BANK OF INDIA SERVICES BOARD Date:30-OCT-2014 OFFICER'S IN GR B (GEN)-DR-BY-2014 (PHASE-II) Result List PATNA PUNE THIRUVANANTHAPURAM AM/Manager AGM General Manager Page 4 of 4

7 भ रत य रज़व ब क/ RESERVE BANK OF INDIA क य क य लय/ CENTRAL OFFICE म नव स स धन ब ध वभ ग/ HUMAN RESOURCE MANAGEMENT DEPARTMENT म बई/ Mumbai स य कन फ म / ATTESTATION FORM च त वन / Warning प सप ट आक र क ह त रत फ ट चपक ए (3.5 स म. X 4.5 स म.) Affix signed passport size (3.5 cm. x 4.5 cm. approx) photograph ट ल /म ब ईल न./ Tel./Mob. No.. 1. स य कन फ म म गलत ज नक र द न अथव कस त य मक ज नक र क छप न अय यत म न ज एग तथ यह उ म दव र क ब क म नय जन क लए अन पय बन द ग The furnishing of false information or suppression of any factual information in the Attestation Form would be a disqualification and is likely to render the candidate unfit for employment in the Bank. 2. य द यह फ म जम करन क ब द उ म दव र क हव ल त म रख गय ह, अ भश त कय गय ह तथ व चत आ द कय गय ह त इसक य र अ वल ब ब क अथव उस धक र जस पहल स य कन फ म भ ज गय ह, ज भ ह, क द ऐस न ह न पर इस त य मक ज नक र क छप न म न ज एग If detained, convicted, debarred, etc. subsequent to the completion and submission of this form, the details should be communicated immediately to the Bank or the authority to whom the attestation form has been sent earlier, as the case may be, failing which it will be deemed to be a suppression of actual information. 3. य द क स व क ल क द र न कस भ समय यह प य गय क स य कन फ म म गलत ज नक र द गई अथव कस त य मक ज नक र क छप य गय ह त उसक स व ए कस भ न टस अथव इसक बदल म तप त क बन सम क ज सकत ह If the fact that false information has been furnished or that there has been suppression of any factual information in the attestation form, comes to notice at any time during the service of the person, his/her services would be liable to be terminated without any notice or compensation in lieu thereof. 1. प र न म उपन म स हत, य द क ई ह (य द कस भ चरण पर आपन अपन न म अथव उपन म म क छ ज ड़ य घट य ह त बत ए ) Name in full (in block capitals) with aliases, if any. (Please indicate if you have added or dropped at any stage any part of your name or surname) 2. वत म न म प र पत (अथ त ग व, थ न तथ जल अथव घर न बर, ल न/गल /र ड़ तथ शहर) Present address in full (i.e. Village, Thana and District or House Number, Lane/Street/Road and Town) 3. (क) (a) घर क प र पत (अथ त ग व, थ न तथ जल अथव घर न बर, ल न/गल /र ड़ तथ शहर तथ जल म य लय क न म) Home address in full (i.e. Village, Thana and District or House Number, Lane/Street/Road and Town and name of the District Headquarters). उपन म/Surname पन/PIN पन/PIN न म/Name (ख) (b) य द म ल प स प क त न क नव स ह त वह क पत तथ भ रत य स घ म व स क त र ख If originally a resident of Pakistan, the address in that country and the date of migration to Indian Union. पन/PIN 1

8 4. उन थ न क य र (आव स क अव ध स हत) जह आप पछल 5 वष क द र न एक ब र म एक वष स अ धक अव ध क लए रह ह वद श (प क त न स हत) म रहन क म मल म जह आप 21 वष क आय करन क ब द एक वष स अ धक समय क लए रह ह, उन थ न क य र दय ज न च हए Particulars of places (with period of residence) where you have resided for more than one year at a time during the preceding five years. In case of stay abroad (including Pakistan), particulars of all places where you have म ह/ Mth. resided for more than one year after attaining the age of 21 years, should be given. स /From तक/To आव स क प र पत (अथ त ग व, थ न एव जल अथव घर वष / Yr. म ह/ Mth. वष / Yr. न., ल न/गल /र ड तथ शहर ) Residential addresses in full (i.e. Village, Thana &District or House No., Lane/Street Road and Town). पछल क लम म लख गए थ न क जल म य लय Name of the District Headquarters of the place mentioned in the preceding column. 5. न म Name i) पत (प र न म उपन म, य द क ई ह, स हत) Father (Name in full with aliases, if any) र यत (ज म स अथव आव स थ न स ) Nationality (by birth and/or by domicile) ज म थ न Place of birth वस य (य द नय जत ह त पदन म तथ क य लय क प र पत द ) Occupation (if employed, give designation & full office address) वत म न ड क पत (य द म त ह त अ तम पत द ) Present postal address (if dead, give last address) घर क थ य पत Permanent Home address ii) म त /Mother iii) प /प त/ Wife/Husband 2

9 6. र यत /Nationality 7. (क) (a) (ख) (b) (ग) (c) 8 (क) (a) (ख) (b) (ग) (c) 9. (क) (a) (ख) (b) (ग) (c) ज म क त र ख (ई व सन म ) Date of birth (in Christian era) वत म न आय /Present Age म क ल शन क समय आय / Age at Matriculation ज म थ न, जल तथ र य जसम यह थत ह Place of birth, District and State in which situated जल तथ र य जसस आप स ब धत ह District and State to which you belong जल तथ र य जसस आपक पत म ल प स स ब धत ह District and state to which your father originally belongs आपक धम Your Religion य आप अन स चत ज त/अन स चत जनज त अथव अ पव क सद य ह? ह य नह म उ र द य द उ र ह ह त उसक न म बत ए Are you a member of a Scheduled Caste/Scheduled Tribe or OBC? Answer Yes or No and if the answer is Yes state the name thereof. य द अ पव ह त य म ल यर स स ब धत ह? If OBC whether you belong to creamy layer? वष क आय स श क थ न तथ क ल व क ल ज म वष दख त ए श क अह त : Educational qualification showing places of education with years in Schools and Colleges since 15 th year of age: क ल/क ल ज क न म प र पत स हत/ व श क त र ख/ छ ड़न क त र ख/ पर उ ण / Name of school/college with full address Date of entering Date of Leaving Examination passed 3

10 11. (क) (a) य द कस भ समय आप नय जत थ त य र द If you have, at any time, been employed give details: ध रत पद क पदन म अथव क य क क र Designations of posts held or description of work अव ध / Period स /From तक/To क य लय, फम अथव स थ न क प र पत Full address of the office, firm or institutions पछल स व छ ड़न क प र क रण Full reasons for leaving previous service (ख) (b) य द पछल नय जन भ रत सरक र/र य सरक र/भ रत सरक र अथव र य सरक र क व म व अथव नय ण व ल उप म/ व य नक य/ व व लय/ थ न य नक य म थ ; य आपन क य ल कस व (अ थ य स व ए ) नयम, 1949 क नयम 5 अथव इस तरह क कस अ य नयम क अ तग त एक म ह क न टस द कर स व छ ड़ थ, य आपक व अन श स नक क य व ह श क गई थ अथव जब आपन स व सम करन क न टस दय अथव ब द म, आपक स व ए सम ह न स पहल, आपस आपक कस म मल म आचरण क स ब ध म प करण म ग गय? If the previous employment was under the Government of India/a state Government/an Undertaking owned or controlled by the Govt. of India or a State Government/an Autonomous Body/a University/a local body: If you had left service on giving a month s notice under rule 5 of the Central Civil Services (Temporary Services) Rules, 1949, or any similar corresponding rules, were any disciplinary proceedings framed against you, or had you been called upon to explain your conduct in any matter at the time you gave notice of termination of services, or at a subsequent date, before your services were actually terminated? 12 (क) (a) (ख) (b) य आपक कभ गर त र कय गय, अ भय ग चल य गय, नजरब द कय गय अथव र क गय / द डत कय गय, कस अपर ध क लए य य लय र अ भश त कय गय अथव कस ल क स व आय ग अथव कस अ य स थ न र पर / चयन क लए उप थत ह न स व चत कय गय ह / अय य ठहर य गय ह अथव व व लय अथव कस अ य श धकरण/स थ न र इसक पर स व चत, न क सत कय गय ह? Have you ever been arrested, prosecuted, kept under detention or bound down/fined, convicted by a court of law for any offence, or debarred/disqualified by any Public Service Commission or any institution from appearing at its examination/selection or debarred from any examination, rusticated by any University or any other educational authority/institution? यह स य कन फ म भरत समय य आपक व क ई म मल य य लय, व व लय अथव कस अ य श धकरण/स थ न म ल बत ह? Is any case pending against you in any court of law, University or any other educational authority/institution at the time of filling up this attestation form? 4

11 (य द (क) अथव (ख) क उ र ह ह त यह फ म भरन क समय म मल, गर त र, नज़रब द, द ड, द ष ठहर न, सज़ आ द तथ य य लय/ व व लय/ श धकरण आ द म ल बत म मल क क त क ब र म प र य र दय ज न च हए) (If the answer to (a) or (b) is Yes full particulars of the case, arrest, detention, fine, conviction, sentence, etc. and the nature of the case pending in the Court/University/Education authority etc. at the time of filling up of this form should be given) ( ट पण : क पय स य कन फ म क श ष पर द गई च त वन भ पढ़ ) (Note Please also see the Warning at the top of this attestation form) 13 स दभ /References न म तथ पत /Names and addresses of: (क) (a) आपक म ह ल /इल क क द ज म द र य क two responsible persons of your locality (1) (अथव /OR) पन/Pin (ख) (b) आपक पहच नन व ल द य क two persons to whom you are known (2) पन/Pin स दभ र त द र स इतर ह न च हए तथ आपक त न स अ धक वष स ज नत ह The references should be other than relatives and should be known to you for more than three years. म म णत करत /करत क प व वत स चन म र अ धकतम ज नक र तथ व स क अन स र सह तथ प ण ह सरक र/ब क म नय जन क लए म र उपय त क द ब ल करन व ल कस भ थ त स म अन भ I certify that the foregoing information is correct and complete to the best of my knowledge and belief. I am not aware of any circumstances which might impair my fitness for employment under Government/Bank. थ न/Place: दन क/Date: उ म दव र क ह त र/Signature of candidate ( ट पण /:क पय कस भ क लम तथ उप क लम क र / बन भर न छ ड़ आप ह अथव नह अव य लख ल ग नह नह लख ) (NOTE: PLEASE DO NOT LEAVE ANY COLUMN AND SUBCOLUMN BLANK/UNFILLED. YOU MUST WRITE EITHER YES OR NO. DO NOT WRITE NOT APPLICABLE) 5

12 पहच न म णप IDENTITY CERTIFICATE म णप न ल खत म स कस एक र ह त रत ह / Certificate to be signed by any one of the following: (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) क य अथव र य सरक र क र जप त अ धक र /Gazetted Officers of Central or State Government; उस नव चन जह उ म दव र अथव उसक म त - पत /अ भभ वक स म यत: रहत ह स स ब धत र य वध नसभ अथव स सद क सद य;/Member of Parliament or State Legislature belonging to the Constituency where the candidate or his/her parent/guardian is ordinarily resident; उपम डल य म ज ट/अ धक र /Sub Divisional Magistrates/Officers; तहस लद र अथव न यब/उप तहस लद र ज म ज ट र अल श य क य ग करन क लए धक त ह ;/Tehsildars or Naib/Deputy Tehsildars authorized to exercise magisterial powers; म यत क ल/क ल ज/स थ न जह उ म दव र न पढ़ ई क ह क ध न च य तथ ध न य पक/Principals and Head Masters of the recognized School/College/Institution where the candidate studied last; ख ड वक स अ धक र /Block Development Officers; प ट म टर; तथ /Post Masters; and प च यत नर क/Panchayat Inspector म णत कय ज त ह क म / मत /क म र... प /प क पछल...वष...म ह स ज नत तथ म र अ धकतम ज नक र तथ व स क अन स र उनक र दए गए ववरण सह ह Certified that I have known Shri/Shrimati/Kumari... son/daughter of Shri for the last Years months and that to the best of my knowledge and belief the particulars furnished by him/her are correct. ह त र/Signature पदन म अथव थ त/Designation or status तथ पत /& address थ न/Place: दन क/Date: (क य लय क रबड़ ट प/Rubber stamp of office) क य लय र भर ज ए/TO BE FILLED BY THE OFFICE नय कत धक र क न म, पदन म तथ पत : Name, designation and address of the appointing authority: भ रत य रज़व ब क/Reserve Bank of India पद जसक लए उ म दव र पर वच र कय ज रह ह : Post for which the candidate is being considered: 6

13 भ रत य रज़व ब क स वस ज़ ब ड RESERVE BANK OF INDIA SERVICES BOARD म बई/ MUMBAI ज वनव फ म /BIO-DATA FORM प सप ट आक र क नव नतम ह त रत फ ट चपक ए / Affix a signed latest passport size photograph आव दत पद/POST APPLIED FOR. र ल न./ ROLLNO. स क र क म यम/MEDIUM OF INTERVIEW:.. 1 प र न म / मत /क. Name in full Shri/Smt./Kum.. (ज स म क ल शन अथव समक म णप म दय गय ह ; य द न म बदल गय ह त आव यक द त व ज स य त त कर ) (As recorded in Matriculation or equivalent certificate; in case of change in name, please produce necessary documentary evidence) 2 वत म न ड क पत /Present Postal address: नजद क र लव ट शन/ Nearest Railway Station: 3 पत /प त क न म तथ वस य: Father s /Husband s name and Occupation:.. 4 वग / Category: अज /SC अजज /ST अ पव/OBC स म य GENERAL 4 क A (उ चत ब स पर टक( ) कर /Tick ( )the appropriate box) (क) अज /अजज क म मल म ज त/उपज त/जनज त लख / (a) in case of SC/ST, Indicate Caste/Sub-caste/Tribe (ख) न:श जन उ म दव र/ (b) Persons with Disability (PWD) Candidate अ. व./ ब धर/ Orthopedically Hearing Handicapped impaired य आप अ पस यक सम द य स स ब धत ह? य द ह त सम द य क न म इ गत कर /Whether you belong to minority द. व./ Visually Handicapped ह /नह :ब /ईस ई/म लम/ स ख/ज र यन Yes/No: community? If so please indicate which community Buddhist/Christian/Muslim/Sikh/Zoroastrian 5 र यत /Nationality:. 6 भ तप व स नक/ ह /नह व स / ह /नह Ex-Serviceman: Yes/No Migrant: Yes/No 7 ई व सन म ज म त थ/Date of Birth in Christian Era: ट फ / Staff: ह /नह Yes/No... /..... /.(DD / MM / YYYY) Registration/ Receipt No.. Page 1 of 4

14 8 अक द मक/तकन क / वस यक अह त (म क ल शन/एस.एस.स. पर स आग )/ Academic/Technical/Professional qualification (Matriculation/S.S.C. Examination onwards) उ ण क गई पर / Examinations Passed 1. मह व लय/ व लय/ College/ School उ ण करन क वष / Year of Passing पर नक य (ब ड / व व लय, आ द)/ Examination Body (Board/University etc.) म य वषय/ Main Subject य स क स य / No. of attempts made अ श स हत अ क क श % / Exact % of marks with fraction ण ड* तथ र क/ Class Grade* and Rank (क) * ड क म मल म उ चत धक र स म णप स सम थत समक अ क/ * In case of Grade exact numerical equivalent to be supported by a certificate from appropriate authority. (a) (ख) (b) (ग) (c) ब क क लए मह वप ण अ त उ अक द मक अथव वस यक अह त /अन भव क य र Particulars of very high academic or professional qualifications/experience of value to the Bank. * पछल /म ज द नय स त म ह क ल व तन (ज स क लम 13 म दश य गय ह ) Gross Salary per month drawn from previous/existing employer (As shown in column 13) च न ज न पर य उ म दव र (क) तथ (ख) क आध र पर त त व तन म न म अ म व तनव / व तनव य ल न क इ छ क ह य द ऐस ह त, कतन तथ इस अन र ध क लए औ च य Whether on the basis of (a) & (b) the candidate would desire to have advance increment/s in the pay scale offered, if selected. If so, how many and the justification for the request प र क र /म डल / श व य क य र Particulars of Prizes/Medals/Scholarship obtained 11 ख ल /अ त र प म ग त व धय म व णत ( य तथ स म न स हत, य द क ई ह ) Proficiency in sports/extra-curricular activities (including credits & distinctions obtained, if any) Registration/ Receipt No.. Page 2 of 4

15 12 अ ज क अल व भ ष क न (( ) क नश न र बत ए )/ Knowledge of Languages other than English (indicate by a tick ( ) mark) भ ष /Language ब ल सकत ह / पढ़ सकत ह / लख सकत ह / पर उ ण, य द क ई/ Can Speak Can read Can write Examination passed, if any 13 वत म न तथ पछल नय जन क य र /Particulars of present and previous employment नय क न म तथ पत /Name & Address of employer अव ध/period स /From तक/To पदन म तथ क य क क त/ Designation and nature of duties तम ह क ल व तन/ Gross Salary drawn p.m. छ ड़न क क रण/ Reason for leaving 14 भ रत य रज़व ब क स वस ज़ ब ड र व पत पद पर भत क लए प व म कए गए य स / Previous attempts for recruitments for post advertised by RBI Services Board (क) (a) पद क न म Name of the Post (ख पर क त र ख (b) Date of Examination (ग) (c) य स क र क लए ब ल य गय थ तथ अ तम प रण म Whether called for interview and the final result 15 य आपक कस ल कस व आय ग/ कस अ य भत ब ड जसम भ रब स वस ज़ ब ड भ श मल ह न उनक कस पर /चयन क लए वव जत कय अथव अय य ठहर य गय ह? य द उ क उ र ह ह त इसक य र द Have you ever been debarred or disqualified by any Public Service Commission/any other Recruitment Board including RBI Services Board for any of their Examination/Selections? If ह /नह Yes/No answer to above is Yes give details Registration/ Receipt No.. Page 3 of 4

16 16 (क) (a) (ख) (b) य आप ऋण- म ह? Are you free from debt? य द आपक श अथव कस अ य उ य क लए कस स थ न अथव प ट र दए गए धन क च क त क द यत आप पर ह त इसक य र द If you are under any liability to repay money advanced by any institution of party for your education or for any other purpose, state the particulars. य द (क) क उ र नह ह त (ख) क उ र प प स द / If answer to (a) is No answer question (b) clearly ह /नह Yes/No ह /नह Yes/No 17 अ त र य र ज उ म दव र द न च ह Additional particulars which the candidate may like to furnish. 18 स ल म णप क तय क य र /Particulars of copies of certificates enclosed म म णत करत /करत क त त कए गए उ य र म र अ धकतम ज नक र एव व sस क अन स र स य, सह तथ प ण ह म यह भ म णत करत /करत क म पद क लए स ब धत व पन म नध रत प त म नद ड क सभ प म प र करत /करत ब क म नय जन क म र उपय त क द ब ल करन व ल कस भ प र थ त स म अन भ I certify that the particulars furnished above are true, correct and complete to the best of my knowledge and belief. I also certify that I fulfil the eligibility criteria laid down for the post in the relative advertisement in all respects. I am not aware of any circumstances which might impair my fitness for employment in the Bank. थ न/Place: उ म दव र क ह त र/Signature of the candidate. दन क/Date: Registration/ Receipt No.. Page 4 of 4

17 घ षण / DECLARATION म प /प नव स म/क ब /शहर जल र य एत द र यह घ षत करत /करत ह क म सम द य क /क ह ज क क म क और श ण वभ ग क दन क क क य लय पन स.36012/22/93 थ. (एस.स.ट.) म न हत आद श क अन स र स व ओ म आर ण क य जन स भ रत सरक र द र एक पछड वग क प म म य ह म यह भ घ षत करत /करत ह क म दन क क उपय त स द भ त क य लय पन क अन स च क क लम 3 म उ ल खत य य /वग (स प न वग ) स स ब धत नह ह I, son/daughter of Shri resident of Village/Town/City District State hereby declare that I belong to the community which is recognized as a backward class by the Government of India for the purpose of reservation in services as per orders contained in Department of Personnel and Training Office Memorandum No.36012/22/93 Estt.(SCT) dated September 08, It is also declared that I do not belong to persons/sections (Creamy Layer) mentioned in column 3 of the Schedule to the above referred Office Memorandum dated September 08, ह त र /Signature न म/Name : पत /Address :

18 Form of Certificate to be produced by Other Backward Classes This is to certify that Shri/Smt./Kum. Son/Daughter of of Village District / Division in the State belongs to the community which is recognized as a backward class under the Government of India, Ministry of Welfare Resolution No /68 93/BCC (C ), dated 10 th September 1993 published in the Gazette of India Extra ordinary Part I Section I dated 13 th Sept Shri/Smt./Kum. and/ or his family ordinarily reside(s) in the Dist./Divn. of the State. This is also to certify that he/she does not belong to the persons/sections (creamy Layer) mentioned in column 3 of the Schedule to the Government of India, Department of Personnel & Training O.M.No.36012/22/93 Estt.(SCT), dated Dated : District Magistrate Deputy Commissioner etc. * Seal *(a) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/ Additional Deputy Commissioner/ Deputy Collector/Ist Class Stipendary Magistrate/ Sub Divisional Magistrate/Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner (not below the rank of Ist Class Stipendary Magistrate). (b) Chief Presidency Magistrate/additional Chief Presidency Magistrate/Presidency Magistrate (c) Revenue Officer not below the rank of Tehsildar ; and (d) Sub Divisional Officer of the area where the candidate and/or his family normally resides. Note : i) The term Ordinarily used here will have the same meaning as in Section 20 of the Representation of the Peoples Act, ii) Where the certificates are issued by Gazetted Officers of the Union Government or State Government they should be in the same form but Countersigned by the District Magistrate or Deputy Commissioner (Certificates issued by Gazetted Officers and attested by District Magistrate/Deputy Commissioner are not sufficient).

19 Form of Certificate to be produced by a Candidate belonging to Scheduled Caste or Scheduled Tribe in support of his/her claim FORM OF SC / ST CASTE CERTIFICATE This is to certify that Shri / Shrimati / Kumari * Son / Daughter * of of village / Town * in District / Division * of the State/Union Territory * belongs to the Caste / Tribe* which is recognized as a Scheduled Caste / Scheduled Tribe* under : # The Constitution (Scheduled Castes) Order, # The Constitution (Scheduled Tribes) Order, # The Constitution (Scheduled Castes) (Union Territories) Order, # The Constitution (Scheduled Tribes) (Union Territories) Order, # [As amended by the Scheduled Castes and Scheduled Tribes Lists (Modification) Order, 1956, the Bombay Reorganisation Act, 1960, the Punjab Reorganisation Act, 1966, the State of Himachal Pradesh Act, 1970, the North Eastern Areas (Reorganisation) Act, 1971 and the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976.] # The Constitution (Jammu & Kashmir) Scheduled Castes Order, # The Constitution (Andaman & Nicobar Islands) Scheduled Castes Order, 1959, as amended by Scheduled Castes and Scheduled Tribes Order (Amendement) Act, # The Constitution (Dadra & Nagar Haveli) Scheduled Castes Order, # The Constitution (Dadra & Nagar Haveli) Scheduled Tribes Order, # The Constitution (Pondicherry) Scheduled Castes Order, 1964.

20 2 # The Constitution (Scheduled Tribes) (Uttar Pradesh) Order, # The Constitution (Goa, Daman & Diu) Scheduled Castes Order, # The Constitution (Goa, Daman & Diu) Scheduled Tribes Order, # The Constitution (Nagaland) Scheduled Tribes Order, # The Constitution (Sikkim) Scheduled Castes Order, # The Constitution (Sikkim) Scheduled Tribes Order, % 2. Applicable in the case of Scheduled Castes / Scheduled Tribes persons who have migrated from one State / Union Territory Administration This certificate is issued on the basis of the Scheduled Caste / Scheduled Tribe Certificate issued to Shri / Shrimati * Father/Mother of Shri/Shrimati/Kumari * 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 the State/Union Territory * issued by the (name of prescribed authority) vide their No. dated % 3. Shri/Shrimati/Kumari* and/or * his / her * family ordinarily reside(s) in village/ town * of District/Division * of the State/Union Territory * of. Place State/ Signature Union Territory Date * * Designation (with Seal of Office)

21 3 * Please delete the words which are not applicable. # Please quote specific Presidential Order. % Delete the paragraph which is not applicable. Note: The term Ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the Peoples Act, ** List of authorities empowered to issue Scheduled Caste/Scheduled Tribe Certificates : 1. District Magistrate / Additional District Magistrate / Collector / Deputy Comissioner / Additional Deputy Commissioner / Deputy Collector / 1 st Class Stipendary Magistrate / City Magistrate / * Sub-Divisional Magistrate / Taluka Magistrate / Executive Magistrate / Extra Assistant Commissioner. * (not below the rank of 1 st class Stipendary Magistrate.) 2. Chief Presidency Magistrate / Additional Chief Presidency Magistrate/Presidency Magistrate. 3. Revenue Officers not below the rank of Tahesildar. 4. Sub-Divisional Officer of the area where the candidate and/or his family normally resides. 5. Administrator / Secretary to Administrator / Development Officer (Lakshadweep Islands).