ANNEXURE -B

APPUCAION FORMIOR CHRIHCAL OFLLGBLITY FOR RISLRVATION

O OBS FOR IUEOER BACKWARDCLASSES IN CIVIL. POSTS AND SERVICLS UNDER
(LNIRAL GOVI. OF INDIA

Sr.

I request you a CERTIFICATE in respect of Reservation for BACKWARD

CLASSES in civil POSTS &SERVICES under Government of India be granted to me.
Given below of the necessary particulars
1. Full name of the Applicant DASARI 9ARIkANAIN
(In BLOCK LETTERS)
2. Gender : FErALE
Date of Birth
4. Complete Resident Address
a) PERMANENT
D. No: y-) Locality: (-feet Rond Village:
Mandal: oNholE District: PRAkAAn Pin code: srJoo |

b) PRESENT (Postal Address)

D. No: 4-| Locality: o-fatkond village:
District:RALAAN Pin code: SeIoo |
Mandal: ohE
HIPDRU
5 Religion YApnvA (oc)
Caste
7 Sub-Caste
8 Issued Caste Certificate In Past YESNÓ
9 Education Certificate Contains Caste YESNO
10 Occupation Group
11. SERIAL NUMBER of the Caste in the
CENTRAL LIST OF OBCs YADAV DAJAR I
12. Name of the Father M sUDHEER
MUDAMANHU L JRAVANTHI
13. Name of the Mother
14. Name of the Husband
Status of the Parents(S))/Husband Father/ Mother/
15.
Husband wife
a) Constitutional Posts PosTAL DEPT
b) Designation
c) 1) Services: CENTRAL/STATE
i) Designation PA PO
ii) Scale of Pay, including
Clarification if any
iv) Date of Appointment of Post
v) Age of the time of Promotion
To Class Ipost (if applicable)
II. EMPLOYMENT IN INTERNATIONAL ORGANIDATION E.G., U.N., UNICEF, WHO
i) Name of the Organization
ii) Designation
iii) Period of Service FROM TO
(Indicate Date)

P.T.0
 I/2//

Ill. A, DEATH/PERMENT INCAPACUION (OMIL PgUp

IF NOT APPI:
1. Date of death / Permanent
Incapacitation putting anOfficer
Out of Service
Details of permanent incapacitation
B
EMPLOYMENT IN PUBLICSECTOR UNDERTAKINGETC
Name of the Organization Enter

Designation
ill. Date of appointment to the Post
C ARMED FORCES INCLUDINGPARA MILITARY
NOT INCLUDEPERSONS HOLDINGCIVIL POSTS)FORCES (THIS WIIL
i
ii.
Designation
Scale of Pay
D.
PROFESSIONAL CLASS (OTHER THAN
ITEM NOS. B&C AND THOSE ENGAGEDTHOSE COVERED IN THE
IN TRADE, BUSINESSAND
INDUSTRY)
i Occupation / Profession
E
PROPERTY OWNERS:
Agricultural land holding owned
by mother /father and minor
Children
Location
Size of holding
a) IRRIGATED (TYPE OF IRRIGATION LAND)
i)
i)
b) UNIRRIGATED
iv) Percentage of Irrigated Land
Holding to statutory ceiling
Limit under State Land Ceiling
Land
v) If land holding is both irrigated /
unirrigated total irrigated land
Holding on the basis of conversion
Formula in State Land Ceiling
vi) Percentage of total irrigated
Land holding to statutory ceiling
Limit as per (vi)
TO BECERTIFIED DISTRCT REVENUE OFFICER NOT LOWER
THAN MANDAL REVENUE OFFCIER / TAHSILDAR

PLANTATION

i. Crops / Fruits
ii. Location
iii. Area of Plantation
 Ing
Backspace
II311

H VAANT LAND AND/OR BUILDING IN URBAN AREA OF URBAN

AGGLEMERATION
Location of Property
Details of Property
I. Use to which it is put

INCOME /WEALTH

Annual lncome from all

Source (Family Income)
(Excluding Salaries and
Income from Agrl. Land)
YES / NO
ii Whether Tax Paid
iii. Whether covered in Wealth
Tax Act. (Yes / No)
(If so furnish details)

16 Family members consisting kv scHvol (Adingion)

17. Purpose of Caste Certificate
18 Ration Card Number
19 Aadhar Number
Any other Information knowledge
20.
certify that the above said particulars are true to the best of my eligible to
21. I OBCs and
belongs to CREAMY LAYER of information being
and belief and that I do not event of any
for OBCs. In the
be considered for postsreservedineligibility being detected before off after the
found false or incorrect of candidature appointment is liable to be cancelled
selection. I understand that my law lor rules.
be liable to such further action as may be provided under
and I shall
Yours faithfully,

OwaoLE Signature of the Candidate

Place: J4ob-2623
Dated:

Contact Details
Procedure (following to be enclosed) Land Line Number:
1) Application * Mobile Number:
Card #
2) Ration Card/Aadhar Card/EPIC particulars # E- Mail ID:
property
3) Applicant Father/Mother Employment
4) Applicant Father/Mother *
Particulars/Income Tax returns (for professionals)
(*-mandatory # any one of them)
4983276lo
 GWSB 47186021
GOVERNMENT OF ANHRA PRADESH
REVENUE DEPARTMENT
Applcatton Mo

OBc2209260s4834
Date : 27/ 09 /2022

OTHERBACKWARD CLASSES (OBO) CERTIEICATE

Govermment of Anadra Pradesh, D.2197.2916)
(As per ISAD2016, Director,Backward Classcs Welfare Department, DASARI Slo /0/o WJo /F/o /MJo /G/o of
This is to certify that Sri/Srimathi/Kumari M SUDHEER YADAV Ongole (Urban)
Sri/Srimsthi/Master/Kumari N VENKA TESWARUU of Ward-47 Village/Wara/Town of
of PRAKASAM District in the Andhra Pradesh State beiongs to
MandayMunicipality of Ongole Revenue Division backward class under Government of India,
is recognized as a
the Yedava (Gola) (0BC) community which
Enpowerment's:
Ministy of Social Justice and acdir art I section L No. L86 daed
13/C9/9
aesoite No, J2011/68r93-B<C{C) dacd 10/09793 publsned nhe G trotnary ar seCIon i o 163 dated 20/10/34
ostorn NO 1201L/9/94-8CC() daccd 19) 10/94 pubshea nne xrooscinary Partisecont No, 88 dated 25/5'
Hesoubon Na 12011/ 795-BCCC) dated 2533 p Czesof Ini Extraordinary Part 1Section) No 60E196
& Resoution No I 0 T 9 d oe16 ublished in the Gazette of kndia Extordinary PMINO 239 09tco 17.12.97
3 Resotto O -cIC ated 03/297 ubished in the GaxeTe of rg y e r t ' T No, 236 Daed 12. 12.97
8 Resoteon No 1201\/6a/98-BCC 3 e h e t the Gazstaof inds Ertragrdnany Pat Isocttated oA/0/2000
9 ResoASIOn No. B hod SD0O oubldießin the Gazstte of tntia troodinary Pen 210 dateá21/09/2000
10 Resoe 011arog-cCici ate& 290972000 publshed n the Gozete n Pant i secton INo. 246 Ssted 6923
1 Reston No, 12015/9y2000-BGCC) aed 6/08001P r e t e of nda Extraondnary Part l sectio 1O . 0 0 4
13
14
Reskstion No 120111f2001-30ondehed ba the Gatie osta xtraonna Part se
Resoiution No. 1201V42002
ated 12/012006
15 AesotoNO 04-EC.catd1232007
lshed in the
C a a c i o a No. 3244 1802
o E O n o r y Part1 secrbn 1to. 2
18 Resouton No 12015/03/2003-3 amched i te GoroytiaBhdinary Pat1 e
19. Resoluion No. 1 2 0 1 / 1 2 0 O 1 1ubeodn the azet andie Exaprinony Prc
a t e d & / t2/2011
ecdon 1
20. ResoBtion NO. 12015/1
his/her Family ordinarily reside(s) in Ward
SriySrimath/Master/Kumaari MSUOHEER YADAV'DASARIand
ot/onggole Revenue Division pf PRAKASAM
47 Village/Ward/Town of ongple (Urban) Mandaynigipaity the
D1strict of Andhra Pradesh State. nentioned in
beong topersorhs fsections (Creamy Layer) training, O.M.No.
This is also to certify.that hefshe does not of Indja, Departnent of Personnel &
Government
couma No.3 of the schedule to the which is modified vide O.M.No.36033/3/2004, Estt. (Res), dt: 09/03/2004
36012/22/93-Estt(SCT)dated:08/O9/93,
dated: 14th October 2008.
and O.M. No.36033/3/2004-Estd.(Res)
Gertitigd BY.

Date:27/09/ 2022 Name :P. MURALI

Designation:Tahsidar
Mandal/MuniclpalltytOngole-Urban)
Rèvenué Divisiòn: Ongolé
STATEi Andhra Pradash

of Gove rnment of Tndia, in

have to mnention the deta lis of Resolution
*The authorty issuing the certiflcate may OBC.
candidate is mentioned as
which the caste of the
Ag amnended fro mtime to túme.

Note
meaning as in Setlon 20 of the Representa tion ot the
The te rm "Ordinanty" used here wll have the same
people Act,1950.
physical signature. And this certiflcate can be vertfied at
This Is digitally slgned Certiticate, does not require the Ce rtificate.
https:/lvSWS9nins.an.NOY,tn by funishlng the appllcation number mentioned in

Ey Signed Page 1 of 1
ane MURALI PASUPULETI
M 27Sep-2022 20 12 37
Rgbon, Approved

Note: This is a Digitally

Digitally Signed Gertificate, does not require physica signatureAHd ths ceticate can be
at www.granawarcsachivalaya ap goVD by iunshiag tae applicaton number
 3TUT Civaant of a AADHAAR

Government of India

Unique ldentification Authority of India INFORMATION

sSS Enrolment No.: 2710/02502/61569
BAadhaar is a proof of identity. not of citizenship
Dasan Pamikanaina
Verify dentity usingSecure OR Code/ Offline XMU Online
CO MSudhee Yadav Dasan Authentication.
4-111 This is electronically generated letter.
202/202
60 feet road last
satyanarayanapuram
Ongole
Ongole
Prakasam Andhra Pradesh - 523001
9989327610
16/052019
lssue
Date:
Signature yalid
CATION

Aadhaar is valid throughout the country.

Aadhaar helps you avail various Government
and non-Government services easily.
Keep your mobile number & email ID updated
e s 5 Jo / Your Aadhaar No.: in Aadhaar.

5503 5571 2727 Carry Aadhaar in your smart phone- use

VID :9134 6043 3141 9152 MAadhaar App.

Government of India
Unique ldentification Authorityof India
JoBoâseu: J5 -5 ik5 o38, 4-111, 60
Download 15/05/2019
Issue
Date:
Dasar Parnikanalna eo g"523001
Js 3JDOB: 13/06/2016
3/FEMALE Address:
Date: C/O: MSudheer Yadav Dasari, 4-111, 60feet
road last, satyanaray anapuram, Ongole,
02 Prakas am,
Andhra Pradesh -523001
02
2021

5503 5571 2727 5503 5571 2727

VID :9134 6043 3141 9152 VID :9134 6043 3141 9152
help @uidai.gov.in b www.uidai.gov.in