Cast Certificate

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CAST CERTIFICATE

This is certify that Shri/Smt/Kumari ________________________________ Son/daughter


of ____________________________________ of village town ______________________ in
District/Division _________________ of the State/Union Territory ________________ belong
to the __________________ Cast/Tribe which is recognized as a Schedule Cast/Schedule Tribe.

This certificate is issued on the basis of the Scheduled Castes/ Scheduled Tribes certificate issued
to Shri/Smt __________________________________ father/mother of Shri/Smt/Kumari
____________________________ of village /town__________________ in district /division
________________ of the state /union Territory ___________________ who belong to the
Cast/Tribe which is recognized as a Scheduled Cast/Schedule tribe________________________.

In the state /union territory ___________________ issued by the ________________ dated


______________________.

Shri/Smt/Kumari ___________________________________and/or his /her family ordinarly


reside(s) in village /Town _________________ of __________________District/Division of the
State /Union Territory of ______________________.

Signature______________________

Designation____________________

(with seal of office)

Place________________

Dated_______________

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