2. Mr/Mrs/Ms..........................son/daughter of.......................resident of village............Tehsil.............District...........Chhattisgarh is of.....caste/tribe is a Scheduled Tribe of State of Chhattisgarh under Article 342 of the Constitution, which is mentioned on the serial number...............of Fourth Schedule of Section 20 of the Madhya Pradesh Reorganization Act, 2000.

Investigation Officer
Inquiry Officer/Member
Chairman
District Level
District Level
District Level
Certificates
Certificates
Certificates
Verification Committee
Verification Committee
Verification Committee
District................
District.............
District............
Chhattisgarh
Chhattisgarh
Chhattisgarh
Form-4D(3)
Form-4D(3)
[ See Rule 17(1)]
Serail No. ...........................
Dated ............................
Verification Certificate
Verification Certificate
(For Other Backward Classes)
(For Other Backward Classes)
(On light-yellow paper)