Eroding Muslim-dominated Barpeta district displacing thousands
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Application form for BC certification of Muslims
Submitted by kashif on Fri, 07/13/2007 - 22:04.
You can download HTML attachment below for a better printout
GOVERNMENT OF ANDHRA PRADESH
BC Welfare (C2) Department
G.O.Ms.No.24 Dated: 12-7-2007
BC Welfare Department – Forms of application and certificate for issue of community, nativity and date of birth certificates relating to Socially and Educationally Backward Classes 0f Muslims -Reg.
FORM – I
FORM OF APPLICATION FOR ISSUE OF COMMUNITY, NATIVITY AND DATE OF BIRTH CERTIFICATE RELATING TO SOCIALLY AND EDUCATIONALLY BACKWARD CLASSES OF MUSLIMS
(Information to be furnished by the applicant himself supported by documentary evidence)
To
The Mandal Revenue Officer/
Revenue Divisional Officer/
Sub/Assistant/District Collector,
___________________________Mandal / Division.
___________________________District.
Sir,
I am in need of a Backward Class Community Certificate for me / for my son / daughter / _______________________ for which the details are given below.
| 1. Name of the applicant in full :
(in block letters) |
___________________________ |
| 2. Sex of the applicant : | ___________________________ |
| 3. a) Father’s Name : | ___________________________ |
| b) Mother’s Name : |
___________________________ |
| 4. Present Postal Address : | ___________________________ |
| 5. Permanent Place of residence : | ___________________________ |
|
6. Age, date of birth and place of birth (If date is not known approximate Year of birth) : |
___________________________ |
|
7.Place of ordinary residence Documents relating to house / Land or other immovable property or Birth Registration certificate or Ration card or School records may be furnished : |
___________________________ |
|
8. If the applicant has been issued a Community certificate in the past byany 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 applicant : | ___________________________ |
|
11. (a) Religion professed by the father of the applicant : |
___________________________ |
|
(b) Religion professed by the mother of the applicant : |
___________________________ |
| 12. (a) Class / Community / Group( including sub-group) of the father: | ___________________________ |
| (b) Class / Community / Group (including sub-group) of the mother: | |
|
13. If to be included under Other Muslim groups under Item No.15 of G.O.Ms.No.23 Backward Classes Welfare (C2) Department ,dated 7th July, 2007: |
___________________________ |
| I hereby declare that I belong to other Muslim groups excluding Syed, Saiyed, Sayyad, Mushaik; Mughal, Moghal; Pathans; Irani; Arab; Bohara, Bohra; Shia Imami Ismaili, 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 | |
| 14. 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. Signature of the Applicant Station: Date: Signature of the Parent / Guardian. Enclosures: FORM-II MANDAL REVENUE OFFICE __________ ________________DISTRICT, A.P. SSID: Appl. No. Date: COMMUNITY, NATIVITY AND DATE OF BIRTH CERTIFICATE 1.This is to Certify that Sri/Smt/Kum_____________________________________ Son/Daughter of Sri._______________________________ of Village/Town_______________________ Mandal________________District____________________ of the State of Andhra Pradesh belongs to__________________Class/ Community/Group which is recognized as under G.O.Ms.No.1793, Education, dated 25-9-1970 as amended from time to time, (B.Cs) and G.O.Ms.No.23, B.C.Welfare (C2) Dept. dated 7.7.2007. 2. It is certified that Sri/Smt./Kum._________________is a native of _________ Village/Town ____________________ Mandal_________________ District of Andhra Pradesh. 3. It is certified that the place of birth of Sri/Smt./Kum______________________is ____________________Village/Town________________________District of Andhra Pradesh. 4. It is certified that the date of birth of Sri/Smt/Kum.___________________ is Day_________ _______ Month____________________Year______________(in words)____________________________________________________as per declaration given by his/her father/mother/guardian and as entered in the school records where he/she studied. Signature Date: Name; Seal Designation:
| Attachment | Size |
|---|---|
| BC Certificate profama GO24.htm | 14.83 KB |
