|
APPLICATION FOR CERTIFICATE FOR ELIGIBILITY FOR RESERVATION OF JOBS FOR OTHER BACKWARD
CLASSES IN CIVIL POSTS AND SERVICES UNDER GOVERNMENT OF INDIA.
--------
To
The Sub-Division
Officer, Thoubal/Kakching
District Manipur.
Sir,
I
request that a certificate in respect of reservation for other Backwards Classes
in Civil Post and services under Government of India be granted to me.
I
give the necessary particulars:
1.
Full name of the applicant:
- _ _ _ _ _ __ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(in
Block Letter)
2.
Date of Birth: - - _ _ _ _ _ __ _
_ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
3.
Complete Residential Address: - _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _
a) Present
Address :- _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _
_ _
b) Permanent
Address:- _ _ _ _ _ _ _ _ _ _ _ _ __
__ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _
4.
Religion :- _ _ _ _ __ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
5.
Caste :- _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __
_ _ _ __ _ _ _ _ _ _ _ _ _ _ _
6.
Sub-Caste:- _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ __ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _
7.
Occupational Group : _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
8.
Serial Number of the Caste :- _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _
In
the Central List of OBCs.
9.
Name of Father :- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
_ _ _ _ _ _ _ _ _ __ _
_
10.
Name of Mother :- _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _
_ _ _ _ __ _ _ _ _
11.
Name of Husband : - _ _ _ _ _ __
_ _ _ _ _ _ _ _ __ _ _ _ _
__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
12.
Status of parents (s) Husband :-
_ ____ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ _
_ _ _ _ _ _ _
(A)
Constitutional
Posts :
i)
Designation :
Father
Mother
B) Government of Cervices : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
i) Cervices
Central/State : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _
ii)
Designation
: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
iii)
Scale
of pay, including
Classification, if any : _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _
iv) Date
of appointment to the post : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _
v) Age
at the age of promotion to Class-I, Post (if applicable) : _ _ _ _ _ _ _ _
_ _ _ _ _ _ _
B
(I) Employment in international Orgn.
e.g. UN, UNDER, WHO
i)
Name of Organisation
:
ii) Designation
:
iii) Periods of service (indicate date) :
B (II) Date/Permanent
in /capacitating (Omit if not applicable):
i)
Date of death/permanent in/capacitating
putting an office out of service :
ii) Details
of permanent incapacitation :
C) Employment
in public sector undertaking etc :
i)
Name of organization
:
ii)
Designation
:
iii)
Date of appointment the post:
D. Armed Forces including para-military forces. ( This
will not included persons holding civil posts) :
i)
Designation:
ii) Scale
of pay :
E. Professional
class (other that these covered in Item Nos. B.& C and those engage in
trade,
business
and Industry).
F. (I)
Property owners .(Agricultural land holdings owner by mother, father and
minor children)
i)
Location :
ii)
Size of holding :
iii)
(a) Irrigated (type
of irrigated land) :
i)
Percentage of irrigated land holding to statutory ceiling limit under
state land ceiling laws.
ii)
If land holding is both imaged / urinated total irrigated land holdings on the basis of conversion formula in land
sealing law.
iii)
Percentage of total irrigated land holding to be statutory ceiling limit
as per (iv).
F (II) Plantation
i)
Crops/Fruit
:
ii)
Location
:
iii)
Area of plantation :
(To be certified by district Revenue Officer not lower
than the rank of Tashildar ).
F.(III) Vacant land and / or building in urban area of
urban agglomeration.
i)
Location of property :
ii)
Details of property :
iii)
Use to which it put :
G. Income/
Wealth.
i)
Annual family income from all sources ( excluding salaries and income
from agricultural
land) :
i)
Whether tax payer (if yes, a
copy of the last three years return furnished)
III)
Whether covered in wealth Tax Act :(If so furnished details)
13. Any other remarks.
14.
I certify that above said particulars are true
to the best of my knowledge and that I do not
belong to
the Creamy Layer of OBCs and eligible to be considered
for posts reserved for OBCs, In
the event of any information being found false or incorrect, or ineligibility
being detect before of
after
the selection, I understand that my candidature / appointment
is liable to be cancelled and
I and I
shall be liable to such further action as may by provided under the low
and/or rules.
Place_________
Yours
faithfully
Dated :-_________________
Signature of the candidate
I
have personally and physically verified all the information furnished by the
applicant and found correct.
S.D.O.
2. The
above person/the applicant does not belong to the category of person mentioned
in column
3 of the schedule to the
office Memorandum No. 3601/22/93-Estt. (SCT), Government of India,
Ministry of
personal, public Grievances and Pensions dated 8th Sept. 1993. On
the subject.
Reservation for other backward classes in civil posts and services under
government of India
Regards.
S.D.O.
|