!

@
Government of West Bengal
Office of the Project Officer-cum-District Welfare Officer
Backward Classes Welfare & Tribal Development, Birbhum
Administrative Building, 2nd Floor, Suri, Birbhum.

Memo. No. .+§.P.t../BCWTD/Birb. D,t,d, ??/q7/ .2024

To

1-3) The Sub Divisional Officer (All), Birbhum

4-22) The Block Development Officers (All), Birbhum

Sub: SOP for issuance of Certificate to Economically Weaker Section

In connection with the subject cited above, this is to inform that the SOP for issuahce -of
Certificate to Economically Weaker Section along with relevant guidelines and annexures are
enclosed herewith.

You are requested to arrange for wide publicity of the same and take necessary action for
submission and processing of EWS applications as per procedure laid down in the SOP with
immediate effect.
Enel- As stated.
District Magmat
Birbhurn

M,m,. No. 1%.y!/.le9BCWTD/Birb D,t,d: .?el.gII..

. 2024

Copy forwarded for information and taking necessary action to:

1) The Additional District Magistrate (All), Birbhum
2) The PC)-cum-DWO, BCW & TD, Birbhum
3-8) The Chairperson (All Municipalities), Birbhum

District Magis'
Birbhum
 SOP in connection with issuance of "EWS Certificate"
1. To apply for EWS Certificate, the applicant, before applying online, will first obtain the following
certificates from concerned office(s):
a) Certificate of permanent residence – Applicants will apply for domicile certificate of SDOs from
place of their permanent residence in e-district portal and obtain print out of the digitally signed certificate.
b) Certificate of Caste/Community - Applicants will obtain certificate for caste /community from
concerned Chairman of Municipality/Pradhan of Gram Panchayet from his place of permanent residence,
issued under valid Memo/Reference no. and date, mentioning the paternal caste / community that the
applicants originally belong. The same must be countersigned by both IBCW and BDO/DMDC after enquiry.
c) Certificate of Annual Family Income in the previous Financial Year - Applicants will apply for
certificate of annual family income in the previous financial year in Annexure – (IA) and obtain the same in
Annexure- (I) from concerned SDOs in urban area through Councilor, Chairman, E.O. / F.O. of municipality
/ BDOs in panchayet area through Member, Pradhan, E.A./Secretary/Sahayak from his place of domicile.
d) Certificate of residential flat and Immovable Assets –
(i) Firstly, applicants will apply for certificate of measurement of residential flat in Annexure – (IIA) and
obtain the same in Annexure- (II) from concerned Chairman through S.A.E. of municipality for urban
area / Pradhan through Nirman Sahayak for rural area.
(ii) Thereafter, the applicants will approach concerned BL&LRO of his place of domicile and apply for
certificate of ‘Immovable Assets’ in Annexure – (IIIA) and obtain the same in Annexure- (III) along with
original copy of Annexure- (II), duly enquired into and verified by the concerned Revenue Inspector.
Note :
❖ The concerned offices (SDO/BDO/BL&LRO/Municipality/Panchayet), responsible for issuance of the above
certificates/annexures must always address the applicants immediately upon receipt of application and dispose
the same at the earliest. A sperate register of each such case must be maintained in every office for future use.
❖ Each of the concerned office conducting enquiry (SDO/BDO for annual income, Panchayat/Municipality for
caste/community, BL&LRO for immovable assets) must preserve the original copy of application by applicant
and duplicate/photocopy of the annexure certificate issued by them for future reference as and when required.
❖ For issuance of annual family income certificate in the previous financial year, gross annual income from all
sources of each of the family members including the applicant, his/her parents, and siblings below the age of 18
years, his/her spouse and children below the age of 18 years must be taken into account.
❖ For issuance of certificate of measurement of residential flat/house and land particulars, properties (as per
physical enquiry and documentary evidence, irrespective of recorded nature) held by each of the family members
including the applicant, his/her parents, and siblings below the age of 18 years, his/her spouse and children below
the age of 18 years in different locations/cities in the states/districts should be enquired into and clubbed together.
❖ The copies of relevant annexure formats as required by applicant will be made available in the following manner-
(A) Format of enquiry report for domicile certificate (Local BDO/Panchayat/Municipality Office/BSKs)
(B) Annexure Formats – (I) and (IA) for issuance of annual income (Local BDO/Panchayat/Municipality Office/BSKs)
(C) Annexure Formats – (II) and (IIA) for certificate of Residential Flat/House (Local Panchayat/Municipality Office/BSKs)
(D) Annexure Formats – (III) and (IIIA) for certificate of Immovable Asset (Local BL&LRO/RI Office/BSKs)
2. After obtaining the above certificates (permanent residence, caste/community, annual family
income, residential flat/house and immovable assets), the applicant will apply for EWS certificate
in online mode from OSCAR portal (https://castcertificatewb.gov.in/) and submit the hardcopies
of duly signed application form, complete in all respect, along with self-declaration/affidavit and
requisite documents as per Check List of documents to the concerned BDO office (for rural areas)/
Municipality (for urban areas) under proper receipt/acknowledgement slip. A photocopy of the
complete set of application and enclosures to be retained with the applicant for future reference.
3. After receiving the application for EWS Certificate, the Inspector BCW&TD of the Block /
Municipality concerned shall conduct enquiry and/or hearing to verify the annual family income,
immovable assets and caste/community status of the applicant within one week from the date of
receipt of the application (format for report of hearing / enquiry is enclosed in Annexure - IV) and
process the application online in OSCAR portal and forward the same to BDO. Accordingly, a
register of all such cases will be prepared in both hardcopy and softcopy (google spreadsheet) as
per Annexure – (V) and the same is to be maintained in continuous manner for each financial year.
4. On completion of enquiry and/or hearing, the BDOs for rural areas / designated D.M.D.C.s for
urban areas will recommend the application for acceptance / rejection (as per the merit of the case)
and process the same from BDO/DMDC login in OSCAR portal and forward hard copies of all
the applications along with the requisite documents, enquiry reports and check list to the concerned
SDOs who shall compile all the applications received under his/her Sub Division and forward the
hard copies of applications along with enclosures to the PO-cum-DWO, BCW & TD, Birbhum.
5. The PO-cum-DWO, BCW & TD, Birbhum will receive the hard copies of EWS applications from
the SDOs and put up the EWS applications along with all the requisite documents, enquiry reports
and check list before the ADM (Dev.), Birbhum after due checking for disposal and issuance of
‘EWS Certificate’ or for rejection of the application.
6. The ADM (Dev.), Birbhum will examine the applications in the light of supporting documents and
enquiry reports and either approve or reject the applications and process the same in OSCAR
portal. Once approved, the ADM (Dev.) shall issue digitally signed EWS Certificate to such
candidates in Annexure - C or Annexure - D whichever is applicable.
7. After issuance of digitally signed EWS Certificate, the same can be downloaded from OSCAR
portal by the applicant himself/herself. One copy of the same shall be preserved along with the
original application along with enclosures for office records.
8. The District Magistrate, Birbhum shall be the Appellate Authority in respect of EWS applications
disposed / Certificates issued by the issuing authority, i.e., ADM (Dev)., Birbhum.
 Check List of Documents required for issuance of "EWS Certificate"

(to be arranged in the sequence as mentioned below)

1. Online application form and Acknowledgement Slip

2. Four copies of recent passport size photographs (preferably in light-coloured clothes with plain

background)

3. Affidavit in prescribed format by the district (Annexure – B) from Executive Magistrate / 1st

Class Judicial Magistrate

4. Copy of attested M.P. Admit/ School Certificate/ Birth certificate

5. Original/ attested copy of domicile certificate from SDO

6. Certificate in support of sub-caste from Pradhan (Panchayet)/Chairman (Municipality)

7. Certificate of Annual Family Income (Annexure – I) from SDO/BDO with required enclosures
[Bank A/C statement each family member for last Financial Year / Copy of service particulars viz. last drawn

pay slip / certificate from the employer in original / copy of I. T. Returns / Salary certificate (for businessman

/ private sector employees / persons having other sources of income), if and where applicable]

8. Certificate of Immovable Assets (Annexure– II & III) from BL&LRO with required enclosures

[Coloured Print of Photograph of the residential flat/house (for house/flat owned by applicant’s family) /

Warison Certificate (Legal Heir Certificate) by competent authority (for residential house/flat owned by

relatives) / Rent receipt of last three months / Rent agreement from the owner of property (if the applicant

resides in a rented house) / Copy of land particulars (deed/parcha) in the name of family members]

9. Three copies of A4 size coloured print out of residential house/flat (either owned/partially

owned/rented house), duly signed by the applicant/owner, concerned N.S. for

Panchayet/S.A.E. for Municipality and Revenue Inspector

[One copy each to be preserved at concerned panchayet, BL&LRO and with application form for office record]

10. Attested/self-attested copies of EPIC, AADHAR and PAN of Applicant and family members

(as and where applicable)

 EWS সার্টির্িকেট েরার জন্য প্রকয়াজন্ীয় র্ন্য়মাবলী/র্ন্কদিশাবলী
১) EWS সার্টির্িকেট ববর েরার জন্য অন্লাইন্ আকবদন্ েরার আকে আকবদন্োরী র্ন্ম্নর্লর্িত শংসাপত্র গুর্ল সংগ্রহ েরকবন্
ে) e-District বপাটিাকল আকবদন্ েকর আকবদন্োরীর র্ন্কজর ন্াকম Domicile Certificate
ি) পঞ্চাকয়ত প্রধান্ (গ্রাম এলাো)/ বপৌরসভার বেয়ারমযান্ (বপৌরসভা এলাো) েতত িে ইসয য হওয়া আকবদন্োরীর জার্তর প্রমাণ স্বরূপ শংসাপত্র (শংসাপকত্র সংর্িষ্ট
অর্িকসর পত্রাঙ্ক সহ জার্তর সয স্পষ্ট উকেি থােকব) অথবা রাজয তার্লোভযক্ত জার্তর বেকত্র মহেযমাশাসে েতত িে ইসয য হওয়া শংসাপত্র
ে) র্ন্র্দিষ্ট বয়াকন্ (Annexure-IA) উপযয ক্ত প্রমাণ এবং ন্র্থপত্রসহ আকবদন্ েকর শহরাঞ্চকল SDO Office (বপৌরসভার োউর্িলর, বেয়ারমযান্, এর্ির্েউর্টভ অর্িসার/
র্িন্যাি অর্িসার – এর মাধযকম) / গ্রামাঞ্চকল BDO Office (পঞ্চাকয়কতর সদসয, প্রধান্, এর্ির্েউর্টভ অ্যাসিস্ট্যান্ট / বসকেটার্র / সহায়ে – এর মাধযকম) বথকে র্বেত
আর্থিে বছকরর র্ন্র্রকি আকবদন্োরীর ন্াকম পার্রবার্রে বার্ষিে আকয়র শংসাপত্র (Annexure-I)
আবশ্যক ন্র্থপত্র : র্বেত আর্থিে বছকর জমা িরকের র্হকসব সহ পর্রবাকরর প্রকতযে সদকসযর ন্াকম থাো বযাকঙ্কর পাসবইকয়র প্রর্তর্লর্প/পর্রবাকরর বোকন্া সদসয
িরকাসর, ববিরকাসর, িরকাসর অ্নু ম াদনপ্রাপ্ত বা সরোর বপার্ষত সংস্থার চাকুরীজীসব হমে আকের মাকসর বপ র্িপ, িমি – ১৬ বা র্বেত আর্থিে বছকরর আকয়র র্ববরণ/
পর্রবাকরর বোকন্া সদসয অ্নয বকামনা বেশ্ার িামে যু ক্ত োকমে এবং বাসষিক উোজিন আয়কমরর আওতাভুক্ত হকল সবগত আসেিক বছমরর আয়কর সরটামনির কসে।
ঘ) র্ন্র্দিষ্ট বয়াকন্ (Annexure-IIA) উপযয ক্ত প্রমাণ এবং ন্র্থপত্রসহ আকবদন্ েকর শহরাঞ্চকল বপৌরসভার বেয়ারমযান্ (বপৌরসভার সংর্িষ্ট ইর্ির্ন্য়ার – এর মাধযকম) /
গ্রামাঞ্চকল পঞ্চাকয়কতর প্রধান্ (পঞ্চাকয়কতর র্ন্মিাণ সহায়ে – এর মাধযকম) বথকে র্বেত আর্থিে বছকরর সনরীমে আকবদন্োরীর পর্রবাকরর সদসযকদর মার্লোন্াধীন্ বসত
বার্ির পর্রমাপ সংোন্ত শ্ংিােত্র (Annexure-II)
আবশ্যক ন্র্থপত্র : A4 Size োেকজ আকবদন্োরীর পর্রবাকরর প্রকতযে সদকসযর ন্াকম থাো সম্পূ ণি বা আংর্শে মার্লোন্াধীন্ বসত বািীর বা ভািাবািীর রর্িন্ ছর্বর
র্তন্ ের্প র্প্রন্ট / সংর্িষ্ট বপৌরসভা বা গ্রাম পঞ্চাকয়ত বথকে প্রাপ্ত বার্ি র্ন্মিাকণর অন্য মর্তর প্রর্তর্লর্প / আংর্শে মার্লোন্াধীন্ বসত বািীর বেকত্র ওয়ার্রশ বা অংশীদার্র
সংোন্ত শংসাপত্র / জর্মর পর্রমাপ সংোন্ত পেিা
ি) র্ন্র্দিষ্ট বয়াকন্ (Annexure-IIIA) এবং বিত বাসির েসর াে িংক্রান্ত শংসাপকত্রর (Annexure-II) আসল প্রর্তর্লর্প বদর্িকয় উপযয ক্ত প্রমাণ এবং ন্র্থপত্রসহ
আকবদন্ েকর সংর্িষ্ট BL&LRO অর্িস বথকে র্বেত আর্থিে বছকরর র্লর্রকি আকবদন্োরীর পর্রবাকরর মার্লোন্াধীন্ স্থাবর িম্পসির (েতর্ষজর্ম, বসত বার্ি এবং
বাসকযােয জর্ম) পর্রমাপ সংোন্ত শ্ংিােত্র (Annexure-III)
আবশ্যক ন্র্থপত্র : সংর্িষ্ট বপৌরসভা বা গ্রাম পঞ্চাকয়ত বথকে প্রাপ্ত বিত বাসির েসর াে িংক্রান্ত শংসাপকত্রর (Annexure-II) আসল প্রর্তর্লর্প এবং উক্ত শংসাপকত্রর
বেকত্র প্রকযাজয আবশ্যক ন্র্থপকত্রর অন্য রূপ প্রর্তর্লর্প সমূ হ
ে) র্ন্র্দিষ্ট বয়াকন্ স্ব-বঘাষণাপকত্রর এর্িকের্ভট [এর্ির্েউর্টভ মযার্জকেট অথবা িার্স্ি ক্লাস জয র্ের্শয়াল মযার্জকেকটর োছ বথকে প্রাপ্ত] (Annexure – B)
২) ের্ম্পউটার বথকে ববর েরা অন্লাইন্ আকবদন্পত্র ও োর ের্প রর্িন্ পাসকপাটি সাইজ ছর্ব (হালো রকির বপাশাে এবং বযােগ্রাউন্ড সহ)
উক্ত শংসাপত্র গুর্ল সংগ্রহ েরা হকল আকবদন্োরী অন্লাইন্ বপাটিাকল আকবদন্ েরকবন্। আকবদন্ েরার সময় ভাকলা েকর বদকি র্ন্কত হকব – ব্লে/বপৌরসভার ন্াম,
আকবদন্োরীর র্ন্কজর ও র্পতার ন্াকমর বান্ান্, গ্রাম/পািা, বপার্স্, থান্া, বমাবাইল ন্ং সহ সমস্ত তথয সর্িে ভাকব পূ রন্ েরা হকয়কছ র্েন্া এবং র্ন্র্দিষ্ট স্থাকন্ সেকলর
সই-স্বাের েরা আকছ র্েন্া এবং ছর্ব আপকলাে হকয়কছ র্েন্া। আকবদন্োরী র্ন্জ দার্য়কে র্ন্র্িত হকবন্ বয অন্লাইন্ িকমি উকেি থাো সমস্ত তথয সর্িে, োরন্
পূ রণ েরা তকথযর র্ভর্িকতই সার্টির্িকেট ববকরাকব।
২) স্বপ্রতযর্য়ত বা বেকজকটে অর্িসার দ্বারা প্রতযর্য়ত আকবদন্োরীর স্কযল সার্টির্িকেট/মাধযর্মে পরীোর অযাের্মট োেি /জন্ম সার্টির্িকেট (আকবদন্পত্র জমা র্দকত
হকল এগুর্লর এের্ট থােকত হকব এবং এিাকন্ উকেি থাো আকবদন্োরীর ন্াম ও র্পতার ন্াম অন্য সাকরই অন্লাইন্ আকবদন্ েরকত হকব)।
৩) স্বপ্রতযর্য়ত বা বেকজকটে অর্িসার দ্বারা প্রতযর্য়ত আকবদন্োরীর আধার োেি, পযান্ োেি ও বভাটার োকেির ের্প (আকবদন্োরী সাবালে হকল) এবং আকবদন্োরীর
র্পতা, মাতা, স্বামী/স্ত্রী (যর্দ র্ববার্হত হন্) সহ পর্রবাকরর বার্ে সদসযকদর (যারা প্রকযাজয) আধার োেি, পযান্ োেি ও বভাটার োকেির ের্প
৪) সংর্িষ্ট কাযিােয়/আর্ধোর্রকের োছ বথকে র্ন্র্দিষ্ট বয়াকন্ প্রাপ্ত স্থায়ী বার্সন্দা (Domicile Certificate) শংসাপত্র, জার্ত শংসাপত্র, বাসষিক আময়র শ্ংিােত্র
(Annexure-I) এবং স্থাবর িম্পসির (কৃসষজস , বিত বাসি এবং বািমযাগয জস ) েসর াে িংক্রান্ত শ্ংিােত্র (Annexure- II & III)। সমস্ত শংসাপকত্রর আসল
প্রর্তর্লর্প আকবদন্পকত্রর সাকথ জমা র্দকত হকব।
# আকবদন্পত্র এবং সংর্িষ্ট ন্র্থপত্র ও শংসাপত্র Check List অন্য যায়ী পরপর েমান্বকয় সার্জকয় র্ন্র্দিষ্ট বপৌরসভা অথবা ব্লে অর্িকস র্ন্র্দিষ্ট র্দকন্ জমা েরকত হকব।
পরবতিী সমকয় বসই আকবদন্পত্র র্ন্র্দিষ্ট ব্লে/বপৌরসভা বথকে সংর্িষ্ট মহেযমাশাসকের অর্িস হকয় বজলা অন্গ্রসর বেণী েলযাণ দপ্তকরর মাধযকম অর্তর্রক্ত বজলা শাসকের
(উন্নয়ন্) েরণ বথকে ইসয য েরা হকব।
## আকবদন্পকত্রর সকে বদওয়া প্রর্তর্ট বজরি ের্প অযাকটকর্স্ে বা বসল্ফ অযাকটকর্স্ে েরা থােকত হকব।
### আকবদন্পত্র জমা বদওয়ার আকে আকবদন্োরী অবশযই সবগুর্ল েেযকমকন্টর এে বসট বজরি েকর র্ন্কজর োকছ বরকি বদকবন্।
#### EWS িাসটিসিমকট িম্পমকি তেয https://castcertificatewb.gov.in/ ওময়বিাইমট োওয়া যামব। বকামনা আমবদনেত্র সক অ্বস্থায় রময়মছ তা জানা যামব
সনম্নসেসেত উোময় –https://castcertificatewb.gov.in/ -> EWS -> Application Check –> Application ID No. সদমেই (Enquiry level-BDO level–
SDO level–ADM Level-Approved/Rejected/Return) সবকল্পগুসে োওয়া যামব। Under Process at োকমে িাসটিসিমকট হমত বাসক আমছ, Approved বেো
োকমে িাসটিসিমকটসট হময়মছ, Rejected োকমে আমবদনেত্র বাসতে এবং Return োকমে আমবদনেত্র ত্রুসটেূ র্ি। Approve হময় যাবার ের আমবদনকারী EWS
িাসটিসিমকমটর সিসজটাে কসে Download Certificate অ্েশ্ন বেমক ববর কমর সনমত োরমবন।
##### EWS িাসটিসিমকট িংক্রান্ত তেয অ্নগ্রির বের্ী কেযার্ দপ্তমরর Memorandum no- 325-PAR(AR)/3P-1/2019 তাং- 09/07/2019 এবং 959-BCW/MR-
52/2019 তাং- 18/05/2023 বেমক সবশ্মদ জানমত োরা যামব।
 EWS অিলাইি আনবদিপনের সনে সংনযানিি িনথপনের িানলিা (ঘেি নলর্স্)
িনথপনের নববরণ (সংনযানিি থািনল ✔ নেহ্ন িা থািনল X নেহ্ন নদনি হনব) ✔ X
নিনদিষ্ট বয়ানি স্ব-ঘ াষণাপনের এনিনেনিট (Annexure – B) [এনিনিউনটি ম্যানিনেট অথবা িার্স্ি ক্লাস
১)
িুনেনিয়াল ম্যানিনেনটর িাছ ঘথনি প্রাপ্ত]
আনবদিপনে নিনির ও বাবার িানম্র বািানির প্রম্াণস্বরূপ আনবদিিারীর ম্াধ্যনম্ি পরীক্ষার অযােনম্ট
২)
িােি / স্কুল সানটিনিনিট / িন্ম সানটিনিনিট
স্থায়ী বাসস্থানির প্রম্াণস্বরূপ e-District ঘপাটিানল আনবদি িনর আনবদিিারীর নিনির িানম্ Domicile
৩)
Certificate
আনবদিিারীর িানির প্রম্াণ স্বরূপ পঞ্চানয়ি প্রধ্াি / ঘপৌরসিার ঘেয়ারম্যাি িিতিি ইসু য হওয়া িংসাপে
৪)
অথবা রািয িানলিািুক্ত িানির ঘক্ষনে ম্হিুম্ািাসি িিতিি ইসু য হওয়া িংসাপে
নবগি আনথিি বছনর আনবদিিারীর িানম্ Annexure-I -এ পানরবানরর সদসযনদর িানম্ BDO/SDO
৫)
িিতিি ইসু য হওয়া বানষিি আনয়র িংসাপে
৫.ি) গি আনথিি বছনর িম্া খরনের নহনসব সহ পনরবানরর সদসযনদর িানম্ থািা বযানের পাসবইনয়র প্রনিনলনপ

৫.খ) োিুরীিীনব সদনসযর ঘক্ষনে নবগি ম্ানসর ঘপ নিপ/ িম্ি – ১৬/নবগি আনথিি বছনরর সযালানর ঘর্স্টনম্ন্ট
অিযািয ঘপিার সানথ যু ক্ত সদনসযর ঘক্ষনে বানষিি উপািিি আয়িনরর আওিািুক্ত হনল নবগি আনথিি
৫.গ)
বছনরর আয়ির নরটানিির িনপ
নবগি আনথিি বছনরর নিরীনখ সংনিষ্ট প্রধ্ানির িাছ ঘথনি Annexure-II – এ আনবদিিারীর পনরবানরর
৬)
ম্ানলিািাধ্ীি বসি বানির পনরম্ানপর িংসাপে
A4 িাগনি আনবদিিারীর পনরবানরর িানম্ থািা সম্পূ ণি বা আংনিি ম্ানলিািাধ্ীি বসি বািীর বা িািাবািীর রনিি
৬.ি)
ছনবর এি িনপ নপ্রন্ট
৬.খ) সংনিষ্ট ঘপৌরসিা বা গ্রাম্ পঞ্চানয়ি ঘথনি প্রাপ্ত বানি নিম্িানণর অিু ম্নির প্রনিনলনপ / বািীর ঘস্কে
৬.গ) আংনিি ম্ানলিািাধ্ীি বািীর ঘক্ষনে ওয়ানরি বা অংিীদানর সংক্রান্ত িংসাপে
নবগি আনথিি বছনরর নিরীনখ সংনিষ্ট সম্নষ্ট িূ নম্ রািস্ব আনধ্িানরনির িাছ ঘথনি Annexure-III - এ
৭)
আনবদিিারীর পনরবানরর ম্ানলিািাধ্ীি িতনষিনম্ এবং বাসনযাগয িনম্ পনরম্াপ সংক্রান্ত িংসাপে
৭.ি) িতনষিনম্র পনরম্াপ সংক্রান্ত পেিা
৭.খ) বাসনযাগয িনম্র পনরম্াপ সংক্রান্ত পেিা [বসি বািী সংলগ্ন িনম্ সহ]
৮) োর িনপ রনিি পাসনপাটি সাইি ছনব [হালিা রনির ঘপািাি এবং বযািগ্রাউন্ড সহ]
আনবদিিারী/আনবদিিারীর নপিা ও ম্ািা/ স্বাম্ী বা স্ত্রী/ িাবালি সন্তাি/ িাবালি িাই ও ঘবাি সহ প্রনিযনির
৯)
আধ্ার িােি, ঘিাটার িােি ও পযাি িানেির িনপ

১০) অিযািয সংনযানিি িনথপনের নববরণ

আনম্ এই ম্নম্ি ঘ াষণা িরনছ ঘয আনবদিপনের সনে উপনরউক্ত সম্স্ত িনথগুনল সংনযানিি রনয়নছ যার নববরণ আম্ার জ্ঞ্যাি ও নবশ্বাস
ম্নি সিয। ঘিানিা িনথ সংনযানিি িা থািনল বা িনথ িুল থািনল িিতিপক্ষ আম্ার আনবদিপে বানিল িরনি পানরি।

_______________________________
িানরখ - আনবদিিারীর পূ ণি স্বাক্ষর
 ANNEXURE-B
Self-Declaration by the applicant seeking Income and Asset Certificate (EWS) in regard to Sub-
Caste/Community, family income and assets or by the guardian in case of minor
I, Sri/Smt _______________________________________ Contact No __________________, son/daughter/wife/ward
of Sri/Smt ______________________________________ am a permanent resident of Vill/Para-__________________,
Gram Panchayet/Ward No.-_____________________, P.O.-_________________, P.S. -____________________,
Block/ Municipality-__________________, Dist.- Birbhum, Pin-____________, West Bengal, do hereby declare that -

1) In the context of Economically Weaker section, details of my family members are:

Name of family members Age Name of family members Age
Applicant yrs. Mother yrs.
Spouse yrs. Father yrs.
1) Minor 1)
Minor
2) yrs. 2) yrs.
Children 3) Siblings 3)

2) I belong to ________________________________________________________________________ sub-caste/ community,

(i) which is not included as reserved sub-caste / community in the Central and the State list.
or
(ii) which is included as reserved community (OBC-A or B) in the State list but not included in the Central list.
(strike out whichever is not applicable)
3) The gross annual income (from salary, agriculture, business, profession etc) of my family from all sources is
Rs ____________ (in words _________________________________________________________________).
[For service holders of govt/semi-govt/PSUs/private companies, salary slip/form-16 annual salary statement in the last F.Y. to be enclosed]
4) Further, I also declare that my family* possess the following assets:
Measurement of
Details of immovable assets immovable asset
Location Mouza Plot No Khatian No

a) Agriculture land __________Acres

b) Residential flat _________Sq. Ft.

c) Residential plot in notified Municipalities _________Sq. Ft.

Residential plot in areas other than
d) notified Municipalities (Panchayet areas)
Sq. Ft.

5) I also certify that the information/statements furnished above in respect of myself / my son / my daughter / my
ward are fully correct and I take full responsibility for the accuracy of the information / statements. If, at any
point of time the. above information / statements are found to be incorrect (partly / fully), I / my son / my daughter
/ my ward shall have to forfeit the benefits received, i.e., EWS certificate & ensuing benefits and shall be liable
to be punished u/s 229 of the Bharatiya Nyaya Sanhita (erstwhile193 of the Indian Penal Code).
Date :
_________________________________________
(Signature of applicant/guardian in case of minor)
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

* Family for this purpose will include the person who seeks EWS certificate, his/her parents, and siblings below the age
of 18 years and also his/her spouse and children below the age of 18 years.
 Annexure - IA
Application for Obtaining Annual Family Income
To,
The Sub Divisional Officer / Block Development Officer
______________________________ Subdivision / Block,
Birbhum
Sir/Madam,
I, Sri./Smt./Miss _____________________________________________, Son/Daughter/wife
of _______________________________________________________, am a permanent resident
of Vill/Para - __________________________, G.P./Ward No - ___________________________,
P.O. - ________________________________, P.S. - _____________________________, Block/
Municipality - ___________________ under _______________ Sub-Division, District – Birbhum.
I am in need of an annual income certificate of my family for the Financial Year of
___________________ in order to apply for EWS certificate. Therefore, I request you to kindly
issue me the said certificate in Annexure-I at the earliest. I do hereby declare that –
1) The gross annual family income of my family (including myself, my parents, my siblings below
the age of 18 years, my spouse and children below the age of 18 years) from all sources in the
financial year _______________________ is Rs __________________________________/-, (in words,
Rupees ___________________________________________________________________________________________________).
2) The occupation of my family members are –
(i) The applicant - ______________________________, (ii) Spouse - ______________________________,

(iii) Mother - ________________________________ , (iv) Father - _________________________________,

(v) Other applicable family member (s) - ________________________________________________________

Documents enclosed:
1) Copy of AADHAR/EPIC of family members (…….)
2) Copy of self-declaration
3) Bank A/C statement of last financial year with respect to each of the family members (mandatory)
4) Copy of service particulars of family members viz. last drawn pay slip (…....) / Certificate from the employer
in original (…....) / copy of I. T. Return and Form – 16 in the preceding Financial Year (…....) / Salary
certificate (for businessman (…....) / private sector employees (…....) / persons having other sources of
income), as and where applicable. (…....)
5) Any other document(s) (…….) [Please specify ………………………..…………………………………………………………]
[Note: write NIL or ‘Not applicable’ if any document is not available or applicable. No field should remain blank]

___________________________
Date: Signature of applicant/
Guardian (in case the applicant is minor)
 Annexure - I
Certificate of Annual Income of Applicant’s Family for issuance of EWS Certificate
(To be issued in the name of applicant/candidate)
Affix recent
Passport
Photograph
of applicant

This is to report that Sri./Smt./Miss _____________________________________________________ , Son/Daughter/wife of

______________________________________ , of Vill/Para - __________________________, G.P./Ward No - _______________________,

P.O. - _____________________________, P.S. - _____________________________, Block/Municipality - ________________________

under ____________________ Sub-Division, District – Birbhum, West Bengal is an applicant intending to apply for EWS
certificate and has applied for certificate of annual income of applicant’s family in Annexure – (IA) on ________________.
As per enquiry, hearing and documentary evidence the following points have been ascertained
1) The gross annual family income particulars of Sri./Smt./Miss _______________________________________________
(including applicant, his/her parents, siblings below the age of 18 years, his/her spouse and children
below the age of 18 years) from all sources in the financial year 2023-2024 is Rs ______________________,
(in words, Rupees ________________________________________________________________________________).
2) The occupation of the family members are –
(i) The applicant - __________________, (ii) Spouse - ________________, (iii) Mother - __________________ ,

(iv) Father - ____________________, (v) Other applicable family member (s) - ___________________________

[Documents to be enclosed – Bank A/C statement each family member for last Financial Year / Copy of service
particulars viz. last drawn pay slip / certificate from the employer in original / copy of I. T. Return and Form – 16 in
the preceding Financial Year / Salary certificate (for businessman / private sector employees / persons having other
sources of income), if and where applicable.]
(1) (2) (3)

___________________________ ____________________________ ________________________________

Signature of Member (Gram Panchayat)/ Signature of Pradhan (Gram Panchayat)/ Signature of E.A./Secretary (Gram Panchayat)/
Signature of Councillor (Municipality) Signature of Chairman (Municipality) Signature of E.O./F.O. (Municipality)
(With Date and Seal) (With Date and Seal) (With Date and Seal)
_________________________________________________________________________________________________________________
As per field enquiry and documentary evidence, this is to report that the information as mentioned above
with respect to annual income of applicant’s family, is enquired into verified to be true.
______________________________________________________
Signature of Designated Charge Officer of Gram Panchayet/ Extension Officer
(With Date and Seal)
_________________________________________________________________________________________________________________
As per enquiry report, this is to certify that the information with respect to permanent residence &
caste/community of applicant and annual income of applicant’s family, as mentioned above, is true and genuine
in the context of Memorandum vide no- 325-PAR(AR)/3P-1/2019 Dt. 09/07/2019 & 959-BCW/MR-52/2019 Dt.
18/05/2023 for issuance of certificate to Economically Weaker Section.

_______________________________________
Seal & Signature of the Block Development Officer (for Block area)/
Sub Divisional Officer (for Municipality area) with date
 Annexure - IIA
Application for Obtaining Certificate for Measurement of Residential Flat/House for EWS

To,
The Pradhan/Chairman
…………………………….…………. Gram Panchayet/Municipality
PS - …………………..………………………., Birbhum

Sir/Madam,
I, Sri./Smt./Miss __________________________________________, Son/Daughter/wife of __________________________________,

am a permanent resident of Vill/Para - __________________________________, G.P./Ward No - _______________________________,

P.O. - ___________________________, P.S. - __________________________________, Block/Municipality - __________________________

under _______________________________ Sub-Division, District – Birbhum,

I am in need of a certificate for Measurement of Residential Flat/House in the name of my family in order to

apply for EWS certificate. Therefore, I request you to kindly issue me the said certificate in Annexure-II at the earliest.

Documents enclosed:
1) Copy of AADHAR/EPIC/Khadyasathi Card of family members (……..….)

2) Copy of approved plan with sketch map of house/flat in the name of family members (……..….)

3) Three coloured print out of photographs of residential house/flat (s) in the name of family members / relative

other than family members / rented house [strike out whichever is not applicable] (……..….)

4) Copy of land particulars (deed/parcha) in the name of family members (……..….)

5) Warison certificate (……..….) [If any family member has partial share in the residential flat/house]

6) Any other document(s) [Please specify ……………………………………..…………………………………………………]

[Note: write NIL or ‘Not applicable’ if any document is not available or applicable. No field should remain blank]

________________________
Date: Signature of applicant/
Guardian (in case the applicant is minor)
 Annexure - II
Enquiry Report on Measurement of Residential Flat/House for issuance of EWS Certificate
(To be issued in the name of applicant/candidate)
Affix recent
Passport
Photograph
of applicant

This is to report that Sri./Smt./Miss __________________________________________________, Son/Daughter/wife

of ___________________________, of Vill/Para - ___________________, G.P./Ward No - ____________________,
P.O. - ____________________, P.S. - _____________________, Block/Municipality - ____________________ under
______________ Sub-Division, District – Birbhum, West Bengal is an applicant intending to apply for EWS certificate
and has applied for certificate of measurement of residential flat/house in Annexure – (IIA) on ___________________.
As per physical enquiry, hearing and documentary evidence the following facts have been
ascertained (Strike off the parts not applicable):
(A) The measurement (total built up area) of the residential flat/house in the name of applicant and
his/her family members (including applicant, his/her parents, and siblings below the age of 18 years,
his/her spouse and children below the age of 18 years) is ____________________________________________ Sq. ft.
[Documents to be enclosed – Coloured Print of photograph of the residential flat/house (duly signed with date and seal on
the photograph by the applicant/owner, concerned N.S. for Panchayet/S.A.E. for Municipality and Revenue Inspector)]
Or,
(B) The residential flat/house is in the name of near relative of applicant who is a person other than
the applicant or his/her family members (as defined in the context of EWS application) and the
share of applicant or his/her family members in the said property is __________________ Sq. ft.
[Documents to be enclosed – Warison Certificate (Legal Heir Certificate) by competent authority and Coloured Print of
Photograph of the residential flat/house (duly signed with date and seal on the photograph by the applicant/owner, concerned
N.S. for Panchayet/S.A.E. for Municipality and Revenue Inspector)]
Or,
(C) The applicant or his/her family members (including applicant, his/her parents, and siblings below
the age of 18 years, his/her spouse and children below the age of 18 years) reside in rented
house/flat/apartment and none of them has any residential flat/house in their name anywhere.
[Documents to be enclosed – Rent receipt of last three months / Rent agreement from the owner of property, Coloured Print
of Photograph of the rented residential flat/house (duly signed with date and seal on the photograph by the applicant/owner,
concerned N.S. for Panchayet/S.A.E. for Municipality and Revenue Inspector)]
[*Residential flat/house owned by each of the family members in different locations/cities in the states/districts have
been clubbed together while applying the property holding test to determine EWS status.
** Residential flats/houses have been measured as per physical visit of constructed property, irrespective of recorded
construction details of house/flat in proposed/approved house plan/sketch by any authority/official
*** Measurement of commercial complex/unit, if any, has also been taken into account while preparing the report]

1) ___________________ 2) __________________
Signature of Nirman Sahayak (Gram Panchayat)/ Signature of Pradhan (Gram Pancha Signature of Pradhan (Gram Panchayat)/
Signature of S.A.E. (Municipality) Signature of Chairman (Municipality) Signature of Chairman (Municipality)
(With Date and Seal) (With Date and Seal)
________________________________________________________________________________________________________________________
(With Date and Seal)

_________________________________
Enquired into and verified by
The Revenue Inspector (With Date and Seal
[to be signed after submission at BL&LRO]
 Annexure - IIIA
Application for Obtaining Certificate of ‘Immovable assets’ for EWS
To,
The Block Land and Land Reforms Officer
…………………..………………………. Block, Birbhum

Sir/Madam,
I, Sri./Smt./Miss …………….……..………….………………, Son/Daughter/wife of …………………………………........………,

am a permanent resident of Vill/Para - …………………………….…..…………, G.P./Ward No - …………………………………….,

P.O. - …..………………..…………..……, P.S. - ….………………….……, Block/Municipality - ………..…………………… under

……………....………. Sub-Division, District – Birbhum,

I am in need of a certificate for Immovable assets in order to apply for EWS certificate. Therefore, I request

you to kindly issue me the said certificate in Annexure-III at the earliest.

Documents enclosed:
1) Original copy of certificate in Annexure-II from the Pradhan/Chairman (…….) of Panchayet / Municipality

2) Copy of AADHAR/EPIC/Khadyasathi Card of family members (…….)

3) Copy of approved plan with sketch map of house/flat in the name of family members (…….)

4) Two coloured print out of photographs of residential house/flat (s) in the name of family members / relative

other than family members / rented house [strike out whichever is not applicable] (……..….)

5) Copy of land particulars (deed/parcha) in the name of family members (…….)

6) Copy of Warison certificate (…….) [If any family member has partial share in the residential flat/house and land]

7) Any other document(s) [Please specify ………………………..…………………………………………………]

[Note: write NIL or ‘Not applicable’ if any document is not available or applicable. No field should remain blank]

____________________________
Date: Signature of applicant/
Guardian (in case the applicant is minor)
 Annexure - III
Certificate – cum - Enquiry report of Immovable asset for EWS application
Valid for the Financial Year of 2023 – 2024
Certificate/Reference No. - ____________________ Date- ____________
This is to report that, the application of Sri./Smt./Kumari_________________________________________________,
Son/Daughter/Wife of _____________________________________________, of Vill/para- _________________________________, G.P./
Ward No- __________________________________, P.O. - _______________________________________, P.S. - _____________________________,
under Block/Municipality, District – Birbhum, West Bengal, vide his
____________________________

application in Annexure – (IIIA) on ______________, has been enquired into as per provisions led
down in the Office Memorandum No. 325-PAR(PR)/3P-1/2019 Dt-09/07/2019 of the Chief Secretary,
Govt. of West Bengal, and No 959-BCW/MR-52/2019 Dt-18/05/2023 of the Secretary, BCW Deptt..
As per physical enquiry and documentary evidence, the information of assets held by the
applicant’s family * (including applicant, his/her parents, spouse, children and siblings below 18
years) in the financial year of 2023-24 are as follows:
(A) Enquiry report of Agriculture Land, Residential Plot:
Residential Plot/Homestead in Notified Residential Plot/Homestead in areas
Agriculture Land
Municipalities other than notified Municipalities
Family Plot No.
Area Area Area Plot No. &
Members (in
Mouza with &
(in Sq
Mouza with Plot No. &
(in Sq
Mouza with
Khatian
J. L. No. Khatian J. L. No. Khatian No J. L. No.
acres) yards) yards) No
No
Self
Father
Mother
Spouse
Other applicable
family members
Total area ………..……………Acres ……….………..Sq. Yards ………………..Sq. Yards

(B) Enquiry report of Residential Flat/House (enquiry report in Annexure-II to be enclosed) :

Measurement of Residential Flat / House (including commercial property, if any)
Family Members in whose
name recorded Total Built Up
Location Mouza with J. L. No. Plot No. & Khatian No
Area (in Sq. ft.)
Self
Father
Mother
Spouse
Other applicable family
members
Total area …………………………Sq ft.
(Please write NIL or N.A. if and where applicable, no field should remain blank)
[*Properties held by each of the family members in different locations/cities in the states/districts have been
clubbed together while applying the land or property holding test to determine EWS status.
** Residential Plots/land particulars have been measured as per applicability of nature, irrespective of recorded
classification of land in Parcha/Deed/RoR]
Certified that the details of findings as reported above with respect to immovable assets in the name of
applicant and applicable family members have been furnished as per enquiry and filed verification.

_________________________________________________ ______________________________________________________________

Revenue Inspector Block Land & Land Reforms Officer

(Signature with Office Seal and Date) (Signature with Office Seal and Date)
 Annexure-IV
Case Diary-cum- Summary Report for issuance of certificate to Economically Weaker Section
An application (Appl. ID - __________________________) in prescribed format (Annexure-A) has been received
for grant of EWS Certificate in favour of Sri/Smt/Miss __________________________________________________, S/O,D/O,W/O
.

_______________________________ of Vill/Para - ________________________, G. P./Ward No - _______________________, P.O.-

________________________, P.S.- __________________________, under _____________________ Block/Municipality, Dist- Birbhum.

List of documents enclosed: -

Type of document Y/N Type of document Y/N
Application form (Annexure – A) Caste Certificate from Pradhan (Panchayet)/Chairman (Municipality)
Four copies of recent Passport size Photos Certificate of Annual Family Income (Annexure – I)
Affidavit in prescribed format (Annexure – B) Report of Immovable Assets (Annexure – II & III)
Copy M.P. Admit/ School Certificate/ Birth certificate Copy of EPIC and AADHAR of Applicant and family members
Domicile Certificate from SDO Copy of PAN of Applicant and family members
Any other document (please specify) -
On verification of documents and hearing this is to report that:
1) As per enquiry and Domicile Certificate from SDO _____________, Birbhum vide certificate no -
____________________ dtd- _____________ the applicant is a permanent resident of the address as stated above.
2) As per enquiry and Caste Certificate issued by the Pradhan/SDO ____________, Birbhum vide memo/certificate
no- ____________ dtd- ________, the applicant belongs to ____________ caste/community which is not included
in SC/ST/OBC in West Bengal [……] or which is included in State list of OBC but not included in Central list […..].
3) As per enquiry and income certificate (Annexure-I) issued by the SDO/BDO _____________, Birbhum vide
certificate no- ____________ dtd- __________, the annual family income of applicant in the financial year of
2023-2024 from all sources is Rs._______________________________./- (in words Rupees ___________________________________________________).
4) As per enquiry and certificate of immovable assets (Annexure- III) from BL&LRO, _______________, Bribhum
vide certificate/Ref. no- _______________ dtd - __________, the measurements of following assets are as follows:
i) Agricultural land- …………………………………… Acres. iii) Residential plot (block area)- ……………………..………..……..….………Sq Yards.
ii) Residential flat- ……………………….…………..……….Sq ft. iv) Residential plot (municipality area) - ………………..………….. Sq Yards.
In view of the above documents and enquiry, it is found that the applicant has satisfied (……….....) / not satisfied (…..…....)
all points as stated in Memorandum vide no- 325-PAR(AR)/3P-1/2019 Dt. 09/07/2019 & 959-BCW/MR-52/2019
Dt. 18/05/2023 for issuance of EWS certificate. Therefore, the application may be accepted ( ) Or the application
…..…….……..….

may be rejected ( ) [Reason for rejection: ___________________________________________________________________________________________________________________________________].

…..…….……..….

Inspector BCW/Addl. Inspector BCW/Designated Officer

_____________________________ , Birbhum
. .

Order Sheet
For acceptance For rejection
May be approved. Application may be rejected for following reason(s):

Block Development Officer/D.M.D.C.(for ULBs) ______________________, Birbhum Block Development Officer/D.M.D.C.(for ULBs) ___________________, Birbhum
May be approved. Application may be rejected for following reason(s):

Sub Divisional Officer, _____________________________________, Birbhum Sub Divisional Officer, _________________________________, Birbhum
May be approved. Application may be rejected for following reason(s):

PO-cum-DWO, BCW & TD, Birbhum PO-cum-DWO, BCW & TD, Birbhum
Approved. Rejected

Additional District Magistrate (Dev.), Birbhum Additional District Magistrate (Dev.), Birbhum
5
4
3
2
1
Sl.

Date

Name of the Applicant

Father's / Husband's
Name

Address
(Vill/Para, GP/Ward)
with Contact No

Caste/
Community

Annual Income of
family

Block/Municipali
ty Name
Annexure – V

Agricultural
land

Residential
flat/House
Immovable Asset

Residential Plot
Format for Manual Register of cases for EWS Application

Block/Municipality’s
Memo & Date

SDO’s Memo & Date

PO BCW & TD’s

Memo & Date

Remarks