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Integrated BC-E Application Form

The application requests information such as the applicant's name, gender, parents' names, address, date and place of birth, community, religion, identification numbers, and a declaration that the information provided is true. Supporting documents that can be provided include documents related to property ownership, birth registration, ration cards, school records, or a previous community certificate. The form is to be submitted to the local Tahsildar office.

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604 views2 pages

Integrated BC-E Application Form

The application requests information such as the applicant's name, gender, parents' names, address, date and place of birth, community, religion, identification numbers, and a declaration that the information provided is true. Supporting documents that can be provided include documents related to property ownership, birth registration, ration cards, school records, or a previous community certificate. The form is to be submitted to the local Tahsildar office.

Uploaded by

ajmalali_mohd
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM I

FORM OF APPLICATION FOR ISSUE OF COMMUNITY, NATIVITY AND DATE


OF BIRTH CERTIFICATE RELATING TO SOCIALY AND EDUCATIONALY
BACKWARD CLASSES OF MUSLIMS
(Information to be furnished by the applicant himself supported by documentary
evidence)
To
The Tahsildar
..
.District.
Sir
I am in need of Backward Class Community Certificate for my Son/Daughter/
. For which the details are give below.
1. Name of the Applicant in full (in Block Letters) :
2. Sex of the Applicant :
3. a) Fathers Name :
b) Mothers Name :
4. Present Postal Address : D.No: Locality:
Village: Mandal:
District: Pincode:
5. Permanent Place of Residence : D.No: Locality:
Village: Mandal:
District: Pincode:
6. Age, Date of Birth and Place of Birth (if date is
not known approx, Year of Birth)
:
7. Place of ordinary Residence Documents related
to house/Land or other immovable property or
Birth Registration Certificates or Ration Card or
School records may be furnished
:
8. If the applicant has been issued a Community
Certificate in the past by any authority, a copy
of such Certificate should be furnished.
:
9. Community for which certificate is claimed
(including Group, Sub-Group)
:
10. Religion professed by the father of the
Applicant
:
11. (a) Religion professed by the Father of the
Applicant
:
(b) Religion professed by the mother of the
Applicant.
:

12. Ration card Number :
13. Aadhaar Number :
14. Mobile :
15. Phone :
16. Email :




(PTO)








::2::

17 (a) Class/Community/ Group (including sub-group) of the father__________________
(b) Class/ Community Group(including sub-group) of the father___________________

18. if to be included under other Muslim groups under Item No.15 of G.O.Ms,. No.23 Backward
Classes Welfare (C2) Department, dated 7
th
July, 2007.

I hereby declare that I belongs to other Muslim groups excluding Syed, Saiyed, Sayyed,
Mushaik, Mughal, Moghal; Pathans: Iranl; Arab; Bohare: Bohara: Shia Imami ismail, Khoja,
Cutchi-Memon; Jamayat; Navayat, and all the synonyms and sub-groups of the excluded groups;
and except those who have been already included in the State list of Backward Classes.

19. Whether the Applicant is

(a) A natural born Son/Daughter of his/her parents ____________________________
OR
(b) Not

DECLARATION

I/We declare that the information furnished by me / us in the application is true and correct, and
the documents appended thereto are genuine and the contents of the documents are true and
correct and that if these are found to be untrue and incorrect, I/We will be liable for prosecution
for furnishing false and incorrect information/ documents under section 10 of the Act No.16 of
1993.


Station: Signature of the Applicant.
Date :


Signature of the Parent/Guardian

Enclosures:
1. Application Form*
2. Caste Certificate issued to the family members#
3. SSC marks memo or DOB extract or Transfer certificate#
4. 1 TO 10th study certificate or DOB certificates issued by Municipality/Gram Panchayath#
5. Ration Card/EPIC Card /AADHAR CARD#
6. Schedule I to IV #

(*-mandatory #-any one of them)

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