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JATI

This document contains an application form for an applicant seeking a caste certificate. The form requests information such as: 1) Applicant's name, father's name, mother's name and guardian's name if parents are unknown. 2) Present and permanent address details. 3) Date of birth, age, gender, marital status, religion, caste, sub-caste. 4) Affidavits from two responsible persons and a village officer verifying the applicant's caste are also required. The applicant must sign declaring that all information provided is true to the best of their knowledge.

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nand kishor
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0% found this document useful (0 votes)
246 views2 pages

JATI

This document contains an application form for an applicant seeking a caste certificate. The form requests information such as: 1) Applicant's name, father's name, mother's name and guardian's name if parents are unknown. 2) Present and permanent address details. 3) Date of birth, age, gender, marital status, religion, caste, sub-caste. 4) Affidavits from two responsible persons and a village officer verifying the applicant's caste are also required. The applicant must sign declaring that all information provided is true to the best of their knowledge.

Uploaded by

nand kishor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Annexure-A

tkfr izek.k i= gsrq vkosnu i=


¼vuqlfw pr tkfr@vuqlwfpr tu tkfr½
vkosnd ds ifjokj ds eqf[k;k tuk/kkj dkMZ la-

1- izkFkhZ dk uke˟
2- vkosnd ds firk dk uke˟
3- vkosnd dh ekrk dk uke˟
4- ekrk&firk dk uke Kkr ugh gksus dh fLFkfr esa laj{kd dk uke
5- fuokl LFkku dk iw.kZ irk˟

¼d½ orZeku irk %&

¼[k½ LFkkbZ irk %&

6- xk¡o@”kgj˟ rglhy˟ ftyk˟ jkT; ˟


7- D;k vki@vkidk ifjokj jktLFkku ds ewy fuoklh gS˟ gk¡ ugh
;fn ugh gS rks vkosnd dk ewy jkT;----------------------ftyk---------------------rglhy----------------------irk--------------------------
8- tUe fnukad% tUe LFkku mez
9- fyax˟ iq:’k efgyk oSokfgd fLFkfr % fookfgr vfookfgr
10- /keZ ¼vkosnd½˟ tkfr˟ vuqlwfpr tkfr@vuqlwfpr tutkfr mi tkfr˟
11- /keZ ¼firk dk½˟ tkfr˟ mi tkfr˟
12- izkFkhZ us f”k{kk O;olk; vkfn esa fdl tkfr /keZ dk vadu dj j[kk gS˟
13- eksckbZy uEcj ¼ftl ij izkFkhZ vkosnu ls lacfa /kr ,l-,e-,l }kjk
lwpuk pkgrk gS½
eSa rlnhd djrk@djrh gw¡ fd mijksDr fooj.k esjh tkudkjh ,oa fo”okl es lgh gSA
fnukad
LFkku
vkosnd ds gLrk{kj
¼i½ xokg˟ %
eSa iq=@iq=h Jh fuoklh foHkkx dk uke in
ij dk;Zjr gwa ,oa “kiFk iwoZd c;ku djrk gwa fd izkFkhZ@izkFkhZ;k iq=@iq=h Jh
fuoklh dks Hkyh izdkj ls tkurk gwa ;s vuqlwfpr tkfr@tutkfr dh mitkfr
dk dh gS] rFkk muds }kjk layXu c;ku esjs le{k fn;k x;k gS tks iw.kZ lR; gSA

¼gLrk{kj xokg@mÙkjnk;h o;fDr½


¼ii½ xokg˟ %
eSa iq=@iq=h Jh fuoklh foHkkx dk uke in
ij dk;Zjr gwa ,oa “kiFk iwoZd c;ku djrk gwa fd izkFkhZ@izkFkhZ;k iq=@iq=h Jh
fuoklh dks Hkyh izdkj ls tkurk gwa ;s vuqlwfpr tkfr@tutkfr dh mitkfr
dk dh gS] rFkk muds }kjk layXu c;ku esjs le{k fn;k x;k gS tks iw.kZ lR; gSA

¼gLrk{kj xokg@mÙkjnk;h o;fDr½


“kiFk&i=
eSa----------------------------------iq=@iq=h Jh---------------------------------fuoklh------------------------------xkao@”kgj------------------------------rglhy---------------------ftyk--------
jktLFkku dk@dh gwAa eS “kiFk iwod Z c;ku djrk@djrh gwa fd %
¼1½ eSa jktLFkku ds vuqlwfpr tkfr@tutkfr dh vf/kÑr lwph esa lfEefyr tkfr---------------------------------------------------dk@dh lnL; gwa
¼2½ eSa mijksDr izdj.kksa dh lk{; gsrq vko”;d izek.k@lk{; miyC/k djkus dks rS;kj gwAa
¼3½ eSa vkSj esjk ifjokj vU; jkT; ls jktLFkku jkT; esa ekbZxzsV ¼foLFkkfir½ gksdj ugha vk;s gSA
¼4½ ;g fd eSaus fdlh Hkh ftys@izns”k ls tkfr dk izek.k i= ugh cuok;k gSA
gLrk{kj “kiFkxzfgrk

tkfr dh iqf’V gsrq izFker;k% jktLo fjdkMZ ;Fkk Hkwfe tekacnh ;k vU; nLrkost vkWuykbZu miyC/k ugh
gksus dh fLFkfr esa gYdk iVokj tk¡p fjiksVZ
Jheku~ eqrkfcd tk¡p] xokgksa ,oa “kiFk i= ds vk/kkj ij vkosnd Jh@Jherh@dqekjh------------------------------------------------------------iq=@iq=h
Jh--------------------------------------------fuoklh-------------------------------------------ds@dh gSA ;g vuqlwfpr tkfr@tutkfr dh tkfr---------------------------------------
dk@dh gSA izkFkhZ dk jk”ku dkMZ uEcj--------------------------------------------------------
fnukad
gLrk{kj iVokjh
gYdk ua--------------------------------------
rglhy---------------------------------------
mi[k.M--------------------------------------
ftyk-------------------------------------------

1- vkosnd dh uohure QksVks ftls vkosnu i= ij fn;s x;s LFkku ij fpidk,a ¼LVsiy ugh djuk gS½
2- Loa; ;k firk dh tkfr ds lk{; gsrq izek.k i= tSls& izFker;k jktLo fjdkMZ ;Fkk Hkwfe dh tekcanh ,oa vko”;d gks
rks uxjikfydk@fodkl izkf/kdj.k@uxj fodkl U;kl@xzke iapk;r }kjk tkjh Hkw[k.M ds iV~Vs ftlesa tkfr vafdr
gks dh izekf.kr izfr ;fn vkWu ykbZu ugha gks rksA
3- vk; izek.k i=@vk; dj fjVuZ lEcU/kh nLrkost dh izfr ;fn vkWuykbZu nLrkost ugha gks rksA
4- vkosnu i= esa fn;s x;s “kiFk i= dks mRrjnk;h O;fDr ls lR;kfir djkosAa
5- nks mÙkjnk;h O;fDr;ksa ds izek.k i= ;Fkk& laln lnL;@fo/kku lHkk lnL;@jktdh; vf/kdkjh&deZpkjh@ftyk
izeq[k@iz/kku@ftyk ifj’kn lnL;@ljiap@xzke lsod@iVokjh@egkikSj ¼lpho½@uxj fuxe lnL;@uxj ikfydk
v/;{k@Ldwy ds gsM ekLVj@lacaf/kr ih-,p-lh-@lh-,p-lh ds MkWDVj@ch-Mh-vks-@lgk;d vfHk;Urk
6- iqjkuk tkfr izek.k i= dh izfr ;fn vkWuykbZu ugh gks rksA

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