CAST CERTIFICATE
This is certify that Shri/Smt/Kumari ________________________________ Son/daughter
of ____________________________________ of village town ______________________ in
District/Division _________________ of the State/Union Territory ________________ belong
to the __________________ Cast/Tribe which is recognized as a Schedule Cast/Schedule Tribe.
This certificate is issued on the basis of the Scheduled Castes/ Scheduled Tribes certificate issued
to Shri/Smt __________________________________ father/mother of Shri/Smt/Kumari
____________________________ of village /town__________________ in district /division
________________ of the state /union Territory ___________________ who belong to the
Cast/Tribe which is recognized as a Scheduled Cast/Schedule tribe________________________.
In the state /union territory ___________________ issued by the ________________ dated
______________________.
Shri/Smt/Kumari ___________________________________and/or his /her family ordinarly
reside(s) in village /Town _________________ of __________________District/Division of the
State /Union Territory of ______________________.
Signature______________________
Designation____________________
(with seal of office)
Place________________
Dated_______________