REVENUE DEPARTMENT, GOVT.

OF NCT OF DELHI
OFFICE OF THE DISTRICT MAGISTRATE
<<SUB-DIVISION>> : <<DISTRICT>>DISTRICT
SCHEDULED CASTE CERTIFICATE

Certificate No. :<< Certificate No>> Photograph of

Date : << Date of Digital Signing >> Beneficiary

This is to certify that << Shri/Smt./Kumari >><<Applicant Name>> <<Son/Daughter/

Wife of >> <<Father’s/Husband’s Name>> of <<village/town>> <<Name of village/town >> in
<<District/Division>> <<Name of District/Division>> of the <<State/Union Territory>>
<<Name of State/Union Territory >> belongs to <<Caste/Sub Caste Name >> caste of <<Name
of State/UT>> which is recognized as a Scheduled Caste under the following:
<<The Constitution (Scheduled Castes) Order, 1950>>
<<The Constitution (Scheduled Castes) (Union Territories) Order, 1951>>
[ As amended by the Scheduled Caste and Scheduled Tribes List (Modification Order) 1956, the Bombay Reorganization Act 1960, The Punjab
Reorganization Act, 1966, The State of Himachal Pradesh Act,1970, The North-Eastern Areas (Reorganization) Act, 1971 and the Schedule
Caste and Schedule Tribes Orders (Amendment) Act, 1976, The Constitution (Scheduled Castes) Orders (Amendment) Act, 1990, The
Constitution (Scheduled Castes and Scheduled Tribes) Orders (Amendment) Act, 2002, The Scheduled Castes and Scheduled Tribes Orders
(Second Amendment) Act, 2002, The Constitution (Scheduled Castes) Order (Amendment) Act, 2007, The Constitution (Scheduled Castes)
Order (Amendment) Act, 2014 and The Constitution (Scheduled Castes) Order (Amendment) Act, 2015]
<<The Constitution (J&K) SC Order 1956>>;
<< The Constitution (Dadar & Nagar Haveli) SC Order 1962>>;
[As amended by The Constitution (Scheduled Castes) Order (Amendment) Act, 2015]
<< The Constitution (Pondicherry) SC Order 1964>>;
<< The Constitution (Sikkim) SC Order 1978>>;
[As amended by The Constitution (Scheduled Castes) Order (Amendment) Act, 2014]

This certificate is issued on the basis of the Scheduled Caste Certificate issued to
<<Shri/Smt./Kumari>><<Name of relative of Applicant>> <<Son/Daughter/ Wife>> of
<<Father’s/Husband’s Name>>, <<Relation with Applicant>> of <<Name of Applicant>> of
<<village/town>> <<Name of village/town>> in <<District/Division>> <<Name of
District/Division>> of the <<State/Union Territory>> <<Name of State/Union Territory >>
who belongs to <<Caste/Sub Caste Name >> caste of <<State/UT Name>> issued by the
<<Issuing Authority of that State/UT>> vide Certificate No. <<Certificate No>> dated
<<Issued date>>

<<Shri/Smt./Kumari>> <<Applicant Name>> and/or his/her family ordinarily reside(s)

in <<village/town>> <<Name of village/town>>in the <<Name of District/Division>> <<
District/Division>> of the <<Name of State/Union Territory >> <<State/Union Territory >>

Digitally Signed by: << Authority Name>>

Designation: <<Designation of Authority>>
Location: <<Location of Signing>>
Date and time of Signing: <<Signing Date & Time>>
1. This certificate is valid as per Information Technology Act 2000 as amended from time to time.
2. The Authenticity of this certificate should be verified at “<<web address for verification>>”. Any discrepancy in
the details on this document when compared to those available on the website renders it invalid.
3. The onus of checking the legitimacy is on the users of the document.
4. In case of any discrepancy please inform the authority issuing this certificate.