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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…………………
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Dated:………………
Place………………..
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Tehsildar
Nihal Singh Wala
CERTIFICATE OF BACKWARD CLASS
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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……………………………………………………………..
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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
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(Applicant)
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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
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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:
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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.
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Place:………………
Date:……………….
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Yours faithfully,
(Signature of the candidate)
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