CERTIFICATE OF BACKWARD CLASS As per report made by………………………Patwari Halqa……...……Distt. Moga on dated ………………………This is to certify that………………….…………………son of/daughter of……………………………………is bonafide resident of……………………………... Tehsil………………………….District ……………….…………………….of Punjab State belongs to……………………………Caste which is recognized as a Backward Class in terms of Punjab Govt. Letter No…………………………………………………………….. 2. As per affidavit given by ……………………………..he does not belongs to any category to Persons/section mentioned in column 3 of the Schedule of Punjab Govt. Department of Welfare Letter No. 1/41/93/RCI-459 Date: 17-1-94 and 1/41/93-RC 11597 Dated: 17-8-2005. and…………………………………………………….. 3. That …………………………………..…………….and/or/his/her Family ordinarily reside(s) in………………………….Tehsil………………………..District………………… m r No………… Dated:……………… Place……………….. e l p o F Tehsildar Nihal Singh Wala CERTIFICATE OF BACKWARD CLASS m a As per report made by………………………Patwari Halqa……...……Distt. Moga on dated ………………………This is to certify that………………….…………………son of/daughter of……………………………………is bonafide resident of……………………………... Tehsil………………………….District ……………….…………………….of Punjab State belongs to……………………………Caste which is recognized as a Backward Class in terms of Punjab Govt. Letter No…………………………………………………………….. S 2. As per affidavit given by ……………………………..he does not belongs to any category to Persons/section mentioned in column 3 of the Schedule of Punjab Govt. Department of Welfare Letter No. 1/41/93/RCI-459 Date: 17-1-94 and 1/41/93-RC 11597 Dated: 17-8-2005. and…………………………………………………….. 3. That …………………………………..…………….and/or/his/her Family ordinarily reside(s) in………………………….Tehsil………………………..District………………… No………… Dated:……………… Tehsildar Nihal Singh Wala Declaration fpnkB ;qhHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHg[Zso$gsBh ;qhHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH tk;hHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHsfj;hbHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH HHHH fibQkHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHw?A Xow Bkb fpnkB eodk jK fe w?AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH iksh Bkb ;pzXs jK I' fe gzikp ;oeko tZb'A nB[;{fus iksh$j'o gZSVh ;q/aDh eoko fdZsh j'Jh j? . m r R.O & A.C. (Applicant) e l p o F sfj;hbdko, w'rk fpnkB ;qhHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHg[Zso$gsBh ;qhHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH m a tk;hHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHsfj;hbHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH fibQkHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHw?A Xow Bkb fpnkB eodk jK fe ;qhHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHdk tk;h j? ns/ HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHiksh Bkb ;pzXs j? I' fe S gzikp ;oeko tZb'A nB[;{fus iksh$j'o gZSVh ;q/aDh eoko fdZsh j'Jh j? . w?A fJBQK B{z iksh s"o s/ ikDdk jK . R.O & A.C. (;ogzu$Bzpodko) sfj;hbdko, w'rk APPLICATION FORM FOR A CERTIFICATE FOR ELIGIBILITY FOR RESERVATION OF JOBS FOR OTHER BACKWARD CLASSES IN CIVIL POSTS AND SERVICE UNDER GOVERNMENT OF PUNJAB To ……………………………………. ……………………………………. Sir, I request that certificate in respect of reservation for other backward classes in civil posts and services under Government of Punjab be granted to me:I give below the necessary Particulars:1. Full Name of the Applicant ………………………………….. ( in Block Letters) 2. Date of Birth. ………………………………….. 3. a) Complete Residential Address ………………………………….. b) Present ………………………………….. c) Permanent ………………………………….. 4. Religion ………………………………….. 5. Caste ……………..…………………… 6. Sub Caste ………………………………….. 7. Occupation Group ………………………………….. 8. Serial Number of the Caste in The State List of OBCs ………………………… 9. Name of Father ………………………………….. 10. Name of Mother ………………………………….. 11. Name of Husband ………………………………….. 12. Status of Parents/Husband ………………………………….. Father Mother Husband A) Constitutional Posts 1) Designation 2) Government Service 3) Service(Central/State) 4) Designation 5) Scale to Pay including Classification if any 6) Age at the time of Promotion (to Class-1 Post (if applicable) 7) Employment in international Organization e.g. Father Mother Husband m r e l p S m a o F 1. III) C) IV) E) F) Name of the organization : ii) Designation iii) Period of Service (Indicates date from…………………………to…………………………… Death/Permanent incapacitation (omit if an applicable) i) Date of Death/Permanent incapacitation putting on officer out of service. ii) Details of Permanent incapacitation Employment in Public Sector undertaking etc. i) Name of the Organization ii) Designation iii) Date of appointment to the Post Armed Forces including Para-Military Forces (This will not include persons holding civil posts) i) Designation ii) Scale of Pay Professional Class (other than those Covered in itme Nos. B & C And those engaged in trade, Business and industry. i) Occupation/Preofesional PROPERTY OWNERS Agricultural Land holding owned by mother, Father & monor children i) Location ii) Size of holding iii) a) Irrigated Type of irrigated Land) i) ii) iii) iv) b) Unirrigated iv) Percentage of irrigated land holding to statutory celling limit under State land calling law: v) If land holding is both irrigated/land holdings on the basis of Conversation formula in state land celling law: Percentage of total irrigated land holding of claiming limit as per iv) Plantation: i) Crops/Fruits: ii) Location iii) Areas of Plantation: m r e l p o F m a S 2. (To be Certified by District Revenue Officer not lower than the rank of Tehsildar) E) III i) ii) iii) Vacant hand/or buildings in urban area of urban agglomeration: Location of Property Details of Property Use to which it is put Father Mother Husband G) Income/wealth: i) Annual family income from all sources: (excluding salaries & income from agricultural land) ii) Whether Tax Payee (Yes/No) iii) Whether Covered in wealth Tax Act (Yes/No) (if so, furnished details) E) Any other remarks, F) I certify that the above said particulars are correct to the best of my knowledge and belief and that I do not belongs to the cremany of OBCs in the event of any information being found false or incorrect or ineligility detected before or after the selection. I understand that my candidate/appointment is liable to be cancelled and shall be liable to such further action as may be provided under the law/or rules. m r e l p m a Place:……………… Date:………………. S o F Yours faithfully, (Signature of the candidate) m r e l p S m a o F