Print Self Declaration Form Revised

This self-declaration is for the issuance of a Caste (OBC) Certificate, affirming that the applicant does not belong to the Creamy layer and that all information provided is accurate. The document outlines the legal consequences of providing false information, including potential imprisonment and fines under the Bharatiya Nyaya Sanhita, 2023. The declaration is signed and dated by the beneficiary, with a provision for a parent's signature if the applicant is a minor.

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Print Self Declaration Form Revised

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Self-Declaration

Temp. Application Id: Applied For:Issuance of Caste (OBC) Certificate

1. That the above contents are correct to the best of my knowledge and belief and nothing has been concealed
therein .

2 That I have gone through the criterion for exclusion of Creamy layer given in Annexure I attached to this
application and state that I do not fall in Creamy layer.

I further affirm that:

3. I am aware that in case the information furnished above is found to be incorrect, I shall be liable for
prosecution under sections 212 & 227 of the Bharatiya Nyaya Sanhita, 2023, which stipulates as under:-

212. Furnishing false Information- whoever, being legally bound to furnish information on any subject to
any public servant, as such, furnishes, as true, information on the subject which he knows or has a reason to
believe to be false,-

(a) shall be punished with simple imprisonment for a term which may extend to six months, or with fine which
may extend to five thousand rupees, or with both;

(b) where the information which he is legally bound to give respects the commission of an offence, or is
required for the purpose of preventing the commission of an offence, or in order to the apprehension of an
offender, with imprisonment of either description for a term which may extend to two years, or with fine, or
with both.

227. Giving false evidence- Whoever being legally bound by an oath or by an express provision of law to
state the truth, or being bound by law to make a declaration upon any subject, makes any statement which is
false, and which he either knows or believes to be false or does not believe to be true, is said to give false
evidence.

4. Providing any false evidance shall be punishable under section 229 of BNS, 2023 which provides
imprisonment for a term upto three years and fine.

Date: 03/04/2025 Signature of Beneficiary :

(Parents Signature in case of minor)

Place:New Delhi

1-0 03/04/2025 21:04:54

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Print Self Declaration Form Revised

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Self-Declaration

Temp. Application Id: Applied For:Issuance of Caste (OBC) Certificate

I further affirm that:

Date: 03/04/2025 Signature of Beneficiary :

(Parents Signature in case of minor)

1-0 03/04/2025 21:04:54

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