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ED 2022 00684081 - Rushikesh
ED 2022 00684081 - Rushikesh
1 : APPLICANT INFORMATION
Full Name of the Applicant: (As Mentioned in Caste Certificate)
Applicants Caste Certificate No.: Caste Certificate Issuing Date: Caste Certificate Issuing District:
1103/2016 23/04/2016 Ahmednagar
Designation of Caste Certificate issuing Authority: Sub Divisional Officer , Sangamner
Name of the Document on which Caste Certificate is Obtained from Competent Authority:
Applicant School LC/TC Father School LC/TC Bonafide Certificate
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Mother Tongue: Marathi Regional Dialect: Hindu God/Goddess Name: Ganpati
Five different surnames of relatives or person from the same caste of the applicant:
2 : APPLICANT ADDRESS
Correspondence Address : Permanent Address:
Limbach Mala , Limbach Mala ,
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4 : APPLICANT'S FAMILY DETAILS
Full Name of Applicant's Father: Bajirao Ramnath Walave
Permanent Address of Father (If Father is not alive, then please mention full address of his last Residence) :
Limbacha Mala. ,
Mirzapur
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5 : FAMILY MIGRATION DETAILS
State Migration
Name of Relative:
Scrutiny Committee:
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When Verification took place? : Caste Validity Certificate No. of relative:
If applicant has applied for caste validity certificate before any committee in state of Maharashtra: Yes No
Name of Committee:
Category: Caste:
Date of Application: Committee Decision: Valid
Invalid
Pending
7 : UPLOAD DOCUMENTS
WOULD YOU LIKE TO TAKE BENEFIT UNDER BLOOD RELATION FROM PATERNAL SIDE, IF ANY? Yes No
(A) Important Primary Document (Mandatory)-Upload Scan copy of Original Certificate/ Document.
(a-3) Original Affidavit (In Specimen Form-3, [Rule - 4(1)] Affidavit of Claimant / Parent(s))
(B) Important Secondary Documentary Evidence Proof Prior to deem Date only to Prove Caste Claim (Atleast one of
the document can be upload)-Upload Scan copy of Original Certificate/ Document or upload Attested copy in case of Xerox.
(b-1) Certified Copy of Birth Certificate of Applicant's or Applicant's Father/Real Elder Uncle/Real Aunt/Grand Father (From Paternal side) issued by Competent Authority Prior to deem Date
(b-2) Certified Copy of Applicant's Primary School Leaving Certificate/School Register's Extract
(b-3) Certified Copy of Applicant's Father Primary School Leaving Certificate/School Register's Extract
(b-4) Certified Copy of School Leaving Certificate/School Register's Extract of Grand Father/Real Elder Uncle'/
Real Aunt (From Paternal Side)
(b-5) If relatives from Paternal side are illiterate, then Birth/Death Extracts of Father/Real Elder Uncle'/ Real Aunt/Grand
Father (From Paternal Side) issued by Competent Authority (Village Extract No.14/Kotwar Book/Nationality Register)
(b-5) Any Other documents supporting Caste claim (Applicant can upload multiple VC under Blood Relation type.)
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(b-7) If any of the above documents are not available, then attach other relevant documents (mention)
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(b-8) Entry of caste mentioned in the documents of blood relatives from paternal side, registered before deemed
date of respective caste category, e.g. sale or purchase deed of land, house or other immovable property,
mortgage deed, agreement, inam sanad through which rights have been transferred
(b-9) Entry of caste of blood relatives from paternal side in National Registration Book mainly from Aurangabad Revenue Division.
(b-10) Documents related to Inam land available in the records of Directorate of Archives revealing the evidence of caste
(b-11) Entry of caste in the extract of Village Mutation Register, documents in the Format of `Ka`, `da`, `ee`, patra, entries
of caste of blood relatives from paternal side mentioned in the documents of old Court proceedings
(b-12) Government and semi-Government certificates containing traditional Occupation of caste in the old Caste System in respect
of ancestors in blood relations from paternal side, entered before deemed date.
(b-13) Old record wherein name of traditional occupation is mentioned as caste In lieu of surname.
(b-14) Sanad or Proceedings before deemed date, in which the tenant has been declared as the landlord, as per the provisions
of the Maharashtra Tenancy and Agricultural Lands Act (LXVII of 1948) or any other law, revealing the entry of caste.
I am producing certified copy of above documents with my application. I declare on oath that the information furnished
by me in this application is true and correct. I am aware that incomplete application will be rejected and responsibility
of making fresh application will be of mine.
Date: 15-09-2022
Applicant's Father/Guardian
Signature/Left Thumb Impression
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