Form-1A
Form-1A
[ See Rule 3(1)]
Application For Social Status Certificate
Application For Social Status Certificate
1.
Name of the Applicant
:
.......................
2.
Father's Name of the Applicant
:
.......................
3.
Applicant's marital status :
:
Married/Unmarried
4.
Name of the Husband (in case of female
applicant)
:
.................
5.
Date of Birth of Applicant
:
................
6.
Caste (For SC only)
:
.....................
7.
Present Address in full
:
Mohalla/Ward.............
Village/Town/City........
Block............Tehsil........
District.................
State....................
8.
Permanent Address in full
:
Mohalla/Ward.............
Village/Town/City........
Block............Tehsil.........
District.................
State....................
9.
Applicant's Date of Birth
(a) if before 10/08/50 for SC and 6/9/50 for ST;
Mohalla/Ward...........
Village/Town/City......
(b) if before 26/12/84 for OBC then, place of
birth of applicant; or if after these dates then permanent
residential address of his Father/ Ancestor
Block...........Tehsil......
District.................State.............
10.
Head of the Family residing on the
above-mentioned address on the above-mentioned date
:
Name.......................... Relation with the
Applicant..........
11.
Details of the places where the Applicant/his
father/ancestors have stayed from 10-8-1950 (with respect to SC),
6-9-1950 (with respect to ST) and 26-12-1984 (with respect to
OBC) till the present day
:
..................
12.
Applicant's Caste/Tribe (including sub-caste)
:
............
13.
Whether it is prescribed for the State or the
District vide Notification dated 26-12-1984, as amended for OBC
under Madhya Pradesh Reorganisation Act, 2000 ? If yes, its
serial number
:
.......................
14.
Attach attested copies of the following
documents :
Details of the attached documents
(1) Below-mentioned documents of
Applicant's/father/ancestors mentioning their caste : -
(a) Revenue document of ancestors (case file);
(b) Jama-Bandi (Survey) or Girdawari B1;
(c) State Settlement; OR
(d) Document of Rights (1954); OR
(e) Survey of Forest Department/Forest Rights
Certificate; OR
(f) Admission Register of educational
institution; OR
(g) Register of Birth or Death; OR
(h) National Register of Citizens (1949); OR
(i) Copy of Caste Certificate, issued earlier to
Father, Ancestor or a relative; OR
(j) Census (1931).
(2) Such domicile certificate or any other
document verifying that ancestors of the applicant were residing
in the geographical limits of Chhattisgarh before the date
10-8-1950 (Scheduled Castes), 6-9-1950 (Scheduled Tribes) or
6-12-1984 (Other Backward Classes);
(3) Family Tree commencing from ancestors to
Caste certificate holder as obtained by Patwari.
Yes/No
(4) If applicant's father is/were an employee of
State Government and in relation to SC/ST/OBC, before dated
10-8-1950, 6-9-1950, 26-12-1984 where resident of existing State
of Madhya Pradesh and were allocated to the State of Chhattisgarh
on State Reorganization, related documents
Yes/No
(5) If the applicant belongs to OBC and his
father/mother is a government employee, document verifying their
post and income certificate or copy of Form 16 of the preceding
financial year
Yes/No
(6) Envelope having full and legible address of
the Applicant bearing adequate postage stamps (in case the
certificate is desired through post)
Yes/No
(7) Affidavit of the Applicant (prescribed in
FORM-2A).
Yes/No
I hereby solemnly affirm that the information contained in the application is true and correct to the best of my knowledge and belief.
Place:
(Applicant's Signature)
Date:
Form-1B
Form-1B
[ See Rule 15(1)]
Office of the........
Sl. No. .....................
Date ..............................
Sub. :
Ref. :
Section 27 • Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013
27. Notice regarding Issuance, Verification or Cancellation of Certificate.
chhattisgarh-scheduled-castes-scheduled-tribes-and-other-backward-classes-regulation-of-social-status-certification-rules-2013-sec-27.json
•
Section 27
{
"act_title": "Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013",
"act_slug": "chhattisgarh-scheduled-castes-scheduled-tribes-and-other-backward-classes-regulation-of-social-status-certification-rules-2013",
"section_label": "Section",
"section": {
"number": "27",
"title": "27. Notice regarding Issuance, Verification or Cancellation of Certificate.",
"chapter": null,
"content": "Form-1A\nForm-1A\n[ See Rule 3(1)]\nApplication For Social Status Certificate\nApplication For Social Status Certificate\n1.\nName of the Applicant\n:\n.......................\n2.\nFather's Name of the Applicant\n:\n.......................\n3.\nApplicant's marital status :\n:\nMarried/Unmarried\n4.\nName of the Husband (in case of female\n\t\t\t\tapplicant)\n:\n.................\n5.\nDate of Birth of Applicant\n:\n................\n6.\nCaste (For SC only)\n:\n.....................\n7.\nPresent Address in full\n:\nMohalla/Ward.............\nVillage/Town/City........\nBlock............Tehsil........\nDistrict.................\nState....................\n8.\nPermanent Address in full\n:\nMohalla/Ward.............\nVillage/Town/City........\nBlock............Tehsil.........\nDistrict.................\nState....................\n9.\nApplicant's Date of Birth\n(a) if before 10/08/50 for SC and 6/9/50 for ST;\nMohalla/Ward...........\nVillage/Town/City......\n(b) if before 26/12/84 for OBC then, place of\n\t\t\t\tbirth of applicant; or if after these dates then permanent\n\t\t\t\tresidential address of his Father/ Ancestor\nBlock...........Tehsil......\nDistrict.................State.............\n10.\nHead of the Family residing on the\n\t\t\t\tabove-mentioned address on the above-mentioned date\n:\nName.......................... Relation with the\n\t\t\t\tApplicant..........\n11.\nDetails of the places where the Applicant/his\n\t\t\t\tfather/ancestors have stayed from 10-8-1950 (with respect to SC),\n\t\t\t\t6-9-1950 (with respect to ST) and 26-12-1984 (with respect to\n\t\t\t\tOBC) till the present day\n:\n..................\n12.\nApplicant's Caste/Tribe (including sub-caste)\n:\n............\n13.\nWhether it is prescribed for the State or the\n\t\t\t\tDistrict vide Notification dated 26-12-1984, as amended for OBC\n\t\t\t\tunder Madhya Pradesh Reorganisation Act, 2000 ? If yes, its\n\t\t\t\tserial number\n:\n.......................\n14.\nAttach attested copies of the following\n\t\t\t\tdocuments :\nDetails of the attached documents\n(1) Below-mentioned documents of\n\t\t\t\tApplicant's/father/ancestors mentioning their caste : -\n(a) Revenue document of ancestors (case file);\n(b) Jama-Bandi (Survey) or Girdawari B1;\n(c) State Settlement; OR\n(d) Document of Rights (1954); OR\n(e) Survey of Forest Department/Forest Rights\n\t\t\t\tCertificate; OR\n(f) Admission Register of educational\n\t\t\t\tinstitution; OR\n(g) Register of Birth or Death; OR\n(h) National Register of Citizens (1949); OR\n(i) Copy of Caste Certificate, issued earlier to\n\t\t\t\tFather, Ancestor or a relative; OR\n(j) Census (1931).\n(2) Such domicile certificate or any other\n\t\t\t\tdocument verifying that ancestors of the applicant were residing\n\t\t\t\tin the geographical limits of Chhattisgarh before the date\n\t\t\t\t10-8-1950 (Scheduled Castes), 6-9-1950 (Scheduled Tribes) or\n\t\t\t\t6-12-1984 (Other Backward Classes);\n(3) Family Tree commencing from ancestors to\n\t\t\t\tCaste certificate holder as obtained by Patwari.\nYes/No\n(4) If applicant's father is/were an employee of\n\t\t\t\tState Government and in relation to SC/ST/OBC, before dated\n\t\t\t\t10-8-1950, 6-9-1950, 26-12-1984 where resident of existing State\n\t\t\t\tof Madhya Pradesh and were allocated to the State of Chhattisgarh\n\t\t\t\ton State Reorganization, related documents\nYes/No\n(5) If the applicant belongs to OBC and his\n\t\t\t\tfather/mother is a government employee, document verifying their\n\t\t\t\tpost and income certificate or copy of Form 16 of the preceding\n\t\t\t\tfinancial year\nYes/No\n(6) Envelope having full and legible address of\n\t\t\t\tthe Applicant bearing adequate postage stamps (in case the\n\t\t\t\tcertificate is desired through post)\nYes/No\n(7) Affidavit of the Applicant (prescribed in\n\t\t\t\tFORM-2A).\nYes/No\nI hereby solemnly affirm that the information contained in the application is true and correct to the best of my knowledge and belief.\nPlace:\n(Applicant's Signature)\nDate:\nForm-1B\nForm-1B\n[ See Rule 15(1)]\nOffice of the........\nSl. No. .....................\nDate ..............................\nSub. :\nRef. :",
"footnote": "",
"is_definition": false,
"sort_order": 26
},
"prev_section": "26",
"next_section": "2"
}