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ANNEXURE B
APPLICATION FORM FOR A CERTIFICATE
FOR ELIGIBILITY FOR
RESERVATION OF JOBS FOR OTHER BACKWARD CLASSES IN CIVIL POSTS
AND SERVICES GOVERNMENT OF INDIA
This form however, shall be used only as a Additional items, if necessary, may be
incorporated to suit to the local situation in the form.
To,
Deputy Collector of SDO
_________–Goa.
I, request that a certificate in respect of reservations for other backward classes posts and
services under Government of India be granted to me.
I give below the necessary particulars:
1. Full name of the Applicants
:
(In Block Letters)
2. Date of Birth
:
3. Complete Residence Address
:
(a) Present
(b) Permanent
4. Religion
:
5. Caste
:
6. Sub-Caste
:
7. Occupation
:
8. Serial Number of the Central
List of OBC’s
:
9. Name of Father
:
10. Name of Mother
:
11. Name of Husband
:
12. Status of Parent (S) Husband
:
Father
Mother
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