Certificate Of Belonging To A Backward Class
Certified that _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Son/Daughter of Shri _ _ _ _ _ _ _ _ _ _ _ _ _ belongs to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Caste which falls in the category of backward class in accordance with the latest _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (State) Govt. Circular No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ dated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ issued by _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (authority).
| Name of the Certifying Officer
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Designation: _ _ _ _ _ _ _ _ _ _ |
Signature of the S.D.M./Tehsidar (with office seal) |