Caste Scrutiny Application Form

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FORM-17
FOR STUDENTS
[rule 14]
Affidavit to be produced along with Caste Scrutiny Application Form
I Shri/Smt.___________________________________________________________________________ age
______years, Occupation ______________________, residing at
____________________________________________________, hereby solemnly affirm today dated ____________
that Caste Certificate of my son/daughter Number _______________________ dated ______________ given by
__________________________________________________________________________ District
___________________________________ is submitted for the Scrutiny.
The documents and proofs attached with the application Form are obtained by me from Competent Authority. These
documents are true and correct and obtained by following proper procedure. No alteration / correction / change are made
in these documents. I affirm hereby that these documents are not duplicate or bogus.
*Caste Certificate of any relative from my paternal side was not invalidated by the Scrutiny Committee.
*And it is not a case that I applied before any Caste Certificate Scrutiny Committee in Maharashtra and my caste
certificate is invalidated.
I will be responsible, if the documents and proofs attached with the application form are found to be incorrect or
bogus, and I am aware that I will be liable for punishment under provision of Indian Penal Code.
I declare that the above mentioned information is true and correct, hence this affidavit.
Place :-
Date :-
--------------------------------------
Signature of the Declarant
************

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