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w[skfpe ;qh HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH iksh Bkb ;pzX oZydk j? ns/ ;qh HHHHHHHHHHHHHHHHHHHHHHHH
dh s;dhe s/ n?;H;hH ;oNhfce/N ikoh ehsk iKdk j? .

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 Annexture 'D'

Certificate for Scheduled Caste

It is Certified that Shri/shrimati/Kumari ____________________________

Son/ dughter of Shri _______________________________________________
of village/town ____________________________________________________
___________________________ Ditrict/Division _________________________
State of punjab belongs to ___________________________Caste which has
been recognised as Scheduled Caste as per The Constitution (Scheduled
Castes), Order 1950"
2. Shri/Shrimati/Kumari _________________________ and his/her family
lives in village/town _______________________District/Division ____________
of Punjab State.

Signature
Designation
Seal of office
Place................
Date ................
To

The Tehsildar
......................

Subject: Issue of Scheduled Caste/S.T/Backward Class Certificate

Sir,
As I belong to .................................... Community which has been
recognised as a Scheduled Caste/Backward class by the constitution of Punjab
State Govt.
Hence it is prayed that a S.C/B.C/Pb. Certificate to be issued to me
and oblige.

Thanking your,

Your faithfully,

Name ...........................................
S/o Sh. .........................................
Full address .................................
.....................................................
Distt.
Dated..................