1. Ranjan Bagdi is applying for a Scheduled Caste certificate as he belongs to the Bagdi caste.
2. He provides details such as his name, father's name, date and place of birth, current and permanent addresses, nationality, religion, sex, Aadhar number, and contact details of two referees.
3. He confirms that his family has always lived in West Bengal and has not migrated from another state or country.
1. Ranjan Bagdi is applying for a Scheduled Caste certificate as he belongs to the Bagdi caste.
2. He provides details such as his name, father's name, date and place of birth, current and permanent addresses, nationality, religion, sex, Aadhar number, and contact details of two referees.
3. He confirms that his family has always lived in West Bengal and has not migrated from another state or country.
1. Ranjan Bagdi is applying for a Scheduled Caste certificate as he belongs to the Bagdi caste.
2. He provides details such as his name, father's name, date and place of birth, current and permanent addresses, nationality, religion, sex, Aadhar number, and contact details of two referees.
3. He confirms that his family has always lived in West Bengal and has not migrated from another state or country.
1. Ranjan Bagdi is applying for a Scheduled Caste certificate as he belongs to the Bagdi caste.
2. He provides details such as his name, father's name, date and place of birth, current and permanent addresses, nationality, religion, sex, Aadhar number, and contact details of two referees.
3. He confirms that his family has always lived in West Bengal and has not migrated from another state or country.
FORM OF ON LINE APPLICATION FOR SCHEDULED CASTE / SCHEDULED TRIBE CERTIFICATE To The Sub-Divisional Officer / D.W.O, Kolkata & Ex-Officio Joint Director, B.C.W, Khatra , Bankura. Sir, I do hereby apply for SC/ST Certificate in the following prescribed proforma, for which particulars are given below. I hereby undertake that the information is correct to the best of my knowledge and belief and if anything found contrary I would be liable for that.
Yours faithfully, Date: (Signature of applicant / gurdian in case of minor) Application No : SCWB13032021/49162 ( Block : RANIBANDH ) 1. (a) Applying for : SC (b) Name of caste : BAGDI 2. Full Name of Applicant : RANJAN BAGDI 5. Contact No. : 3. Father's Name : MADHU BAGDI 6. Email Id. : 4. (a) Date of Birth : 14/06/1995 (b) Place of Birth : 7. Adhar No. :
Village / Ward Police Station District State
RUDRA RANIBANDH BANKURA WEST BENGAL
8. Address since birth :
(a) Present address : Para / House No. / Road / Village Ward No. / G.P. Post Office District State PIN RUDRA RUDRA RUDRA BANKURA WEST 722135 BENGAL (b) Other address(s) : Para / House No. / Road / Village Ward No. / G.P. Post Office District State PIN
9. Nationality : INDIAN 10. Religion : Hinduism 11. Sex Male
12. Whether any of the blood relations of the applicant posseses Caste Certificate? Yes If answer to point no. 12 is 'Yes': Name of cert. holder Relation with applicant Certificate No. Date of Issue Issuing authority SAYEN BAGDI REAL SISTER WB1303SC2021046475 27/09/2021 Khatra
13. Details of two(2) referees:
Name of 1st referee Address of 1st referee Name of 2nd referee Address of 2nd referee MADHU BAGDI RUDRA,RUDRA,RANIBANDH DULAL BAGDI RUDRA,RUDRA,RANIBANDH,
14. Whether the applicant or his family migrated from other State / Country? No If point no. 14 is 'Yes': Migration Certificate No. : Date of Issue Address of the applicant in his/her state of origin. Village / Ward Police Station District State Country Year
Date: ( Signarure of applicant / gurdian in case of minor )
