Application Form For Scheduled Caste And Scheduled Tribe Certificate

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GOVERNMENT OF MEGHALAYA
APPLICATION FORM FOR SCHEDULED CASTE/TRIBE CERTIFICATE
UNDER eDISTRICT MMP FOR FC/PFC/CSC etc.
Photograph
(Please use CAPITAL letters to fill in the application form)
A. Application Details
1. Application for ST-SC Certificate
SC
ST
2. Name of the Office to whom application is made:
______________________________________________________
B. Applicant Details:
1. Applicant’s Name in Full: *(Shri/ Smti/Kumari)
(First Name)
(Middle Name)
(Last Name)
2. Alias (if any) :_________________________________________________________________________
3. Gender *:
Male
Female
Others
4. Previous Name (if changed) : ___________________________________________________________
5. Maiden Name / Birth Name (if any):______________________________________________________
6. Date of Birth *:
(dd/mm/yyyy)
7. Age *:_________________________ 8.
Place of Birth :_______________________________
9. Caste/ Tribe * :________________________ 10. Nationality *:__________________________
11. Religion *:______________________
12. Mobile No. *: ___________________ 13. E-mail :______________________________________
14. EPIC No. :________________________15.
Aadhaar Number : ____________________________
16. Date of Entry to Meghalaya:
(Fill 16 & 17 if applying for
(dd/mm/yyyy)
SC Certificate)
17. Place resided before entry into Meghalaya:_____________________________________________
No 18.b . If Yes, Name of the House Owner *
18. Whether staying in Rented House? *
Yes
*
Non. Govt. Servant
Student
Govt. Servant
Business
Unemployed
19. Present Occupation:
*
*
*
( If Govt. Servant or non-Govt. Servant )
Name of Organization_____________ Designation ____________ Place of Posting________
C. Permanent Address:
20. State *:__________________________ 21. District *:_______________________________________
22. Village/ Town*:___________________ 23. Locality *:______________________________________
24. Sub-Locality :____________________ 25. Nearest Landmark :______________________________
2 6. Post Offi ce *:_____________________ 27 . Police Station / Outpost *:__________________________
D. Present Address:
Same as address above
Yes
28. State *:__________________________ 29. District *:_______________________________________
30. Village/ Town*:___________________ 31. Locality *:______________________________________
32. Sub-Locality :____________________
33. Nearest Landmark :______________________________
34. Post Office* :_____________________ 35. Police Station/Outpost *:
E. Parents/Guardian Details:
__________________________
36. Father’s Name in Full (Shri/Dr./Lt.)*: ___________________________________________
38. Father’s Nationality*:_____________________________
(
): SC
ST
General
39. The community of Father *
Tick
39.b. Caste/Tribe___________
40. Father’s Religion *:_________________
41. Mother’s Name in Full (Smti/Dr./Lt. *: ________________________________________________________________
42. Mother’s Nationality *:____________________________
(
): SC
ST
General
Tick
43. The community of Mother*
43.b. Caste/Tribe___________
44. Mother’s Religion *:________________
_______________________________________________________
46
. Guardian’s Name in
Full (Shri/Smti/Mr/Mrs/Dr):
:_______________
47
.
Self/Fathe
r’s /Mother’s /Guardian’s
EPIC No.*

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