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FORM FOR A CERTIFICATE FOR ELIGIBILITY RESERVATION FOR OBC/NT(A)/NT(B)


Applicant's Name : *
                  First Name

Middle Name

Last Name

Birth Date : *

/ /

Residential Address (Present) : *
   Pin code :    Ward :

Residential Address (Permanent) : *


Mobile No :



Religion :



Caste :



Sub-Caste :

;

Occupational group :



Serial no of the caste in the state list of OBC :



Father's Name :
                  First Name

Middle Name

Last Name

Mother's Name :
                  First Name

Middle Name

Last Name

Parent's/husband's details :
     (a) Constitutional post :



     (b) Designation :




(A) Government Services/Other services :

     (i) Service (Central/State/Other) :



     (ii) Designation :



     (iii) Scale of pay including :
           Classification if any



     (iv) Date of appointment to post :



     (v) Age at the time of promotion :
          To class/post (if Applicable)



   II Employment in International :
      Organisation e.g. UNICEF



      (a) Name of the Organisation :



      (b) Designation :



      (c) Period of service indicate date from :



(B) Death Permanent incapacitation  :
      (omit if not applicable)



     (a) Date of Death / Permanent :
           Incapacitation Putting an Officer of service.



     (b) Details of permanent incapacitation :
           To class/post (if Applicable)



(C) Employment in public sector  :
      Undertaking Put organization/ Profession



     (a) Name of the Organisation :



     (b) Designation :



     (c) Date of appointment of the post :



(D) Armed forces including para-Military  :
      forces.(The Will not Include persons holding the Post)



(E) Professional Class (other than those) :



(F) Property :



(F) Agriculture Land holding owned :
Mother, Father and minor Children



(a) Location :



(b) Size of holding :



(c) (a) Irrigated



(i) :



(ii) :



(iii) :



            (b) Non- Irrigated
                 (To be certified by District Statutory
                  Revenue Officer not Lower than)



                    (iv) Percentage of irrigated land holding to :
                          selling limit under state of Land Selling
                          Lacs



                    (v) If land holding is not irrigated unirrigated  :
                         total irrigated land holding on the basic of
                         conversion formula in State Land Selling
                         Law



                   (vi) Percentage of total Irrigated land holding :
                         to Statutory Selling Hands as per (IV)



(H) II Plantation :
      (i) Crops / Fruits :



      (ii) Location :



      (iii) Area of plantation :



(I) Vacant land and/or building and urban areas :
      (i) Location of property :



      (ii) Detail of property :



      (iii) use to without input :




(J) Income / wealth :
      (i) Annual frankly income excluding salary
          and income from agricultural land :




      (ii) Whether tax payer :



      (iii) Whether converted in wealth tax :



(K) Any other remark :



    
 
 
     
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