EWS PWD OBC Certificate Formats

FORM-GEN-EWS
Government of ………………………………….
(Name & Address of the authority issuing the certificate)
INCOME & ASSET CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER

SECTIONS
Certificate No. Date:
VALID FOR THE YEAR _
1. This is to certify that Shri/Smt./Kumari son/daughter/wife of

permanent resident of ,
Village/Street Post Office District in
the State/Union Territory Pin Code _ whose photograph in attested
below belongs to Economically Weaker Sections, since the gross annual income* of his/her
“family”** is below Rs. 8 lakh (Rupees Eight Lakh only) for the financial year . His/her
family does not own or possess any of the following assets***:
I. 5 acres of agricultural land and above;

II. Residential flat of 1000 sq. ft. and above;
III. Residential plot of 100 sq. yards and above in notified municipalities;
IV. Residential plot of 200 sq. yards and above in areas other than the notified municipalities.
2. Shri/Smt./Kumari belongs to the caste which is not

recognized as a Schedule Caste, Schedule Tribe and Other Backward Classes (Central List).
Signature with seal of Officer

Name
Designation
Recent Passport size

attested photograph The income and assets of the families as mentioned
of the applicant would be required to be certified by an officer not
below the rank of Tehsildar in the States/UTs.
* Note1: Income covered all sources i.e. salary, agricultural, business, profession, etc.
** Note2: The term “Family” for this purpose include the person, who seeks benefit of reservation, his/her
parents are siblings below the age of 18 years as also his/her spouse and children below the age of 18 years.
*** Note3: The property held by a “Family” in different locations or different places/cities have been clubbed
while applying the land or property holding test to determine EWS status.
FORM-PwD (III)
Form-III
Disability Certificate
(In cases of multiple disabilities)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
(See rule 4)
Recent PP size
Attested
Photograph
(Showing face only)
of the person with
disability
Certificate No. Date:
This is to certify that I have carefully examined Shri/Smt./Kum.

son/ wife/daughter of Shri
Date of Birth (DD/MM/YY) Age years,
male/female Registration No.
permanent resident of House No. Ward/Village/Street
Post Office District
State ,
whose photograph is affixed above, and are satisfied that:
1. He/she is a Case of Multiple Disability. His/her extent of permanent physical impairment/
disability has been evaluated as per guidelines (to be specified) for the disabilities ticked
below, and shown against the relevant disability in the table below:
S. No. Disability Affected Diagnosis Permanent physical

Part of Body impairment/mental
disability (in %)
1 Locomotor disability @
2 Low vision #
3 Blindness Both Eyes
4 Hearing impairment £
5 Mental retardation X
6 Mental-illness X
@ - e.g. Left/Right/both arms/legs
# - e.g. Single eye/both eyes
£ - e.g. Left/Right/both ears
2. In the light of the above, his/her overall permanent physical impairment as per guidelines
(to be specified), is as follows:
In figures: percent
In words: percent
3. The above condition is progressive/ non-progressive/ likely to improve/ not likely to

improve.
4. Reassessment of disability is:

(i) not necessary
Or
(ii) is recommended/after years months, and therefore this certificate
shall be valid till (DD/MM/YY)
5. The applicant has submitted the following document as proof of residence:
Nature of Document Date of Issue Details of authority issuing certificate
6. Signature and seal of the Medical Authority:
Name and Seal of Member Name of Seal of Member Name and Seal of the Chairperson
Signature / Thumb
impression of the
person in whose
favour disability
certificate is issued
FORM-OBC-NCL
OBC-NCL Certificate Format
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD
CLASSES (NCL) APPLYING FOR ADMISSION TO CENTRAL EDUCATIONAL
INSTITUTIONS (CEIs), UNDER THE GOVERNMENT OF INDIA
This is to certify that Shri/Smt./Kum* Son/
Daughter* of Shri/Smt.* of Village/
Town* District/Division* in the
State/Union Territory belongs to the
community that is recognized as a backward class under
Government of India**, Ministry of Social Justice and Empowerment’s Resolution No.
dated ***
Shri/Smt./Kum. and/or
his/her family ordinarily reside(s) in the District/Division of
the State/Union Territory. This is also to certify that he/she
does NOT belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule
to the Government of India, Department of Personnel & Training O.M. No. 36012/22/93- Estt.
(SCT) dated 08/09/93 which is modified vide OM No. 36033/3/2004 Estt.(Res.) dated
09/03/2004, further modified vide OM No. 36033/3/2004-Estt. (Res.) dated 14/10/2008, again
further modified vide OM No.36036/2/2013-Estt (Res) dtd. 30/05/2014.
District Magistrate /
Deputy Commissioner /
Any other Competent Authority
Dated:
Seal
* Please delete the word(s) which are not applicable.
** As listed in the Annexure (for FORM-OBC-NCL)
*** The authority issuing the certificate needs to mention the details of Resolution of
Government of India, in which the caste of the candidate is mentioned as OBC.
NOTE:
(a) The term ‘Ordinarily resides’ used here will have the same meaning as in Section 20 of the
Representation of the People Act, 1950.
(b) The authorities competent to issue Caste Certificates are indicated below:
(i) District Magistrate/ Additional Magistrate/ Collector/ Deputy Commissioner/ Additional Deputy
Commissioner/ Deputy Collector/ Ist Class Stipendiary Magistrate/ Sub-Divisional magistrate/
Taluka Magistrate/ Executive Magistrate/ Extra Assistant Commissioner (not below the rank of
Ist Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tehsildar’ and
(iv) Sub-Divisional Officer of the area where the candidate and/or his family resides
ANNEXURE for FORM-OBC-NCL
Sl. No. Resolution No. Date of Notification

1 No.12011/68/93-BCC(C) 13.09.1993
2 No.12011/9/94-BCC 19.10.1994
3 No.12011/7/95-BCC 24.05.1995
4 No.12011/96/94-BCC 09.03.1996
5 No.12011/44/96-BCC 11.12.1996
6 No.12011/13/97-BCC 03.12.1997
7 No.12011/99/94-BCC 11.12.1997
8 No.12011/68/98-BCC 27.10.1999
9 No.12011/88/98-BCC 06.12.1999
10 No.12011/36/99-BCC 04.04.2000
11 No.12011/44/99-BCC 21.09.2000
12 No.12015/9/2000-BCC 06.09.2001
13 No.12011/1/2001-BCC 19.06.2003
14 No.12011/4/2002-BCC 13.01.2004
15 No.12011/9/2004-BCC 16.01.2006
16 No.12011/14/2004-BCC 12.03.2007
17 No.12011/16/2007-BCC 12.10.2007
18 No.12019/6/2005-BCC 30.07.2010
19 No. 12015/2/2007-BCC 18.08.2010
20 No.12015/15/2008-BCC 16.06.2011
21 No.12015/13/2010-BC-II 08.12.2011
22 No.12015/5/2011-BC-II 17.02.2014

EWS PWD OBC Certificate Formats

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EWS PWD OBC Certificate Formats

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FORM-GEN-EWS

INCOME & ASSET CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER

Certificate No. Date:

VALID FOR THE YEAR _

1. This is to certify that Shri/Smt./Kumari son/daughter/wife of

I. 5 acres of agricultural land and above;

2. Shri/Smt./Kumari belongs to the caste which is not

Signature with seal of Officer

Recent Passport size

Certificate No. Date:

This is to certify that I have carefully examined Shri/Smt./Kum.

S. No. Disability Affected Diagnosis Permanent physical

3. The above condition is progressive/ non-progressive/ likely to improve/ not likely to

4. Reassessment of disability is:

5. The applicant has submitted the following document as proof of residence:

Nature of Document Date of Issue Details of authority issuing certificate

6. Signature and seal of the Medical Authority:

Sl. No. Resolution No. Date of Notification

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