SC/ST Certificate Proforma
FORM OF CERTIFICATE TO BE PRODUCED BY SCHEDULED CASTES OR SCHEDULED TRIBES CANDIDATES
This is to certify that Shri/Shrimati/Kumari* _________________________________son/daughter* of
____________________________________of Village/Town*_____________________ District/Division*
________________________________of State/Union Territory* _____________________belongs to the
__________________Scheduled Caste/Scheduled Tribe* under :-
* The Constitution (Scheduled Castes) Order, 1950
* The Constitution (Scheduled Tribes) Order, 1950
* The Constitution (Scheduled Castes) (Union Territories) Order, 1951
* The Constitution (Scheduled Tribes) (Union Territories) Order, 1951
[As amended by the Scheduled Castes and Scheduled Tribes Lists (Modification Order) 1956, the Bombay
Reorganisation Act, 1960, the Punjab Reorganisation Act, 1966, the State of Himachal Pradesh Act, 1970, the North
Eastern Areas (Reorganisation) Act, 1971, the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act,
1976 and the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 2002]
* The Constitution (Jammu and Kashmir) Scheduled Castes Order, 1956;
* The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959, as amended by the Scheduled
Castes and Scheduled Tribes Order (Amendment) Act, 1976;
* The Constitution (Dadara and Nagar Haveli) Scheduled Castes Order, 1962;
* The Constitution (Dadara and Nagar Haveli) Scheduled Tribes Order, 1962;
* The Constitution (Pondicherry) Scheduled Castes Order, 1964;
* The Constitution (Uttar Pradesh) Scheduled Tribes Order, 1967;
* The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968;
* The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968;
* The Constitution (Nagaland) Scheduled Tribes Order, 1970;
* The Constitution (Sikkim) Scheduled Castes Order, 1978;
* The Constitution (Sikkim) Scheduled Tribes Order, 1978;
* The Constitution (Jammu and Kashmir) Scheduled Tribes Order, 1989;
* The Constitution (Scheduled Castes) Order (Amendment) Act, 1990;
* The Constitution (Scheduled Tribes) Order (Amendment) Act, 1991;
* The Constitution (Scheduled Tribes) Order (Second Amendment) Act, 1991;
2. # This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes* Certificate issued to
Shri/Shrimati* ___________________________________________________________ father/mother* of Shri/Shrimati
/Kumari*_____________________________of Village/Town*__________________________in District/Division*
____________________________of the State State/Union Territory* ___________________________ who belong to the
Caste/ Tribe* which is recognised as a Scheduled Caste/Scheduled Tribe* in the State/Union Territory*
____________________ issued by the ________________________ dated____________.
3. Shri/Shrimati/Kumari* ___________________________ and/or* his / her* family ordinarily reside(s)** in
Village/Town* ________________________ of _______________________ District/Division* of the State Union
Territory* of _______________________.
Signature: ______________________
Designation ______________________
(with seal of the Office)
Place: ________________ State/Union Territory* _____________________
Date: ________________
* Please delete the word(s) which are not applicable.
* Please quote specific Presidential Order
* Delete the paragraph which is not applicable
# Applicable in the case of SC/ST Persons who have migrated from another State/UT.
IMPORTANT NOTES
1. The term “ordinarily reside(s)**” used here will have the same meaning as in Section 20 of the Representation of the People Act,
1950.
2. Officers competent to issue Caste/Tribe certificates:
(i) District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner/Deputy
Collector /Ist Class Stipendiary Magistrate/City Magistrate/Sub-Divisional Magistrate/Taluka Magistrate/Executive
Magistrate/Extra Assistant Commissioner.
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officers not below the rank of Tehsildar.
(iv) Sub-divisional Officer of the area where the candidate and/or his family normally reside(s).
(v) Administrator/Secretary to Administrator/Development Officer (Lakshdweep Island).
3. Certificate issued by any other authority will be rejected
