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                 This is to certify that Mr./ Miss./ Mrs. ................................................. son / daughter of ......................of village............................District/Division........................in the..........................State................................belongs to the..............................................community which is recognised as a backward class under the Government of India, Ministry of Welfare Resolution NO.12011/68/93-BCC(C), dated 10th Sept. 1993 published in the Gazette of India Extraordinary Part I Section I dated 13th Sept. 1993.

             Shri.........................and / or his family ordinarily reside(s) in the..................District / Division 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 8.9.93

District Magistrate,

Deputy Commissioner etc.

      Dated:

                                 Seal


NB: (a) The term ‘ordinarily’ used here will have the same meaning as in Section 20 of the Representation of the               Peoples Act,1950.

       (b) Where the certificates are issued by Gazetted Officers of the Union Government or State Governments, 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).

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