FORM-GEN-EWS

Government of ………………………………….
(Name & Address of the authority issuing the certificate)

INCOME & ASSET CERTIFICATE TO BE PRODUCED BY ECONOMICALLY

WEAKER SECTIONS (EWS)

Certificate No. Date

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 2023-2024. 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 includes the person, who seeks benefit of reservation, his/her
parents and 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-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, and
again further modified vide OM No. 36033/1/2013-Estt (Res) dtd. 13/09/2017.

District Magistrate /
Deputy Commissioner /
Any other Competent Authority
Dated:

Seal

* Visit http://www.ncbc.nic.in for latest guidelines and updates on the Central List of State-wise OBCs.
** 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
(v) Certificate issued by any other authority will be rejected
ANNEXURE for FORM-OBC-NCL

Sl. No. Resolution No. Date of Notification

1 No.12011/68/93­BCC(C) 13.09.1993
2 No.12011/9/94­BCC 19.10.1994
3 No.12011/7/95­BCC 24.05.1995
4 No.12011/96/94­BCC 09.03.1996
5 No.12011/44/96­BCC 11.12.1996
6 No.12011/13/97­BCC 03.12.1997
7 No.12011/99/94­BCC 11.12.1997
8 No.12011/68/98­BCC 27.10.1999
9 No.12011/88/98­BCC 06.12.1999
10 No.12011/36/99­BCC 04.04.2000
11 No.12011/44/99­BCC 21.09.2000
12 No.12015/9/2000­BCC 06.09.2001
13 No.12011/1/2001­BCC 19.06.2003
14 No.12011/4/2002­BCC 13.01.2004
15 No.12011/9/2004­BCC 16.01.2006
16 No.12011/14/2004­BCC 12.03.2007
17 No.12011/16/2007­BCC 12.10.2007
18 No.12019/6/2005­BCC 30.07.2010
19 No. 12015/2/2007­BCC 18.08.2010
20 No.12015/15/2008­BCC 16.06.2011
21 No.12015/13/2010­BC­II 08.12.2011
22 No.12015/5/2011­BC­II 17.02.2014
23 No. 12011/04/2014­BC­II 14­01­2015
24 No. 12011/7/2014­BC­II 23­01­2015
25 No. 12011/1/2015­BC­II 27­05­2015
26 No. 12015/05/2011­BC­II 15­07­2015
27 No. 12011/06/2014­BC­II 09­09­2015
28 No. 12011/13/2016­BC­II 25­05­2016
29 No. 12011/14/2016­BC­II 15­06­2016
30 No. 12011/15/2016­BC­II 30­06­2016
31 No. 12011/04/2014­BC­II 11­08­2016
32 No. 12011/6/2014­BC­II 07­12­2016
33 No. 12011/13/2016­BC­II 22­12­2016
34 No.20012/1/2017­BC­II 19­01­2017
35 No. 12011/7/2017­BC­II 31­07­2017
 FORM-SC-ST
SC/ST Certificate Format
FORM OF CERTIFICATE TO BE PRODUCED BY SCHEDULED CASTES (SC) AND
SCHEDULED TRIBES (ST) CANDIDATES

1. 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.

# Applicable in the case of SC/ST Persons who have migrated from another State/UT.

IMPORTANT NOTES
The term “ordinarily reside(s)**” used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950.
Officers competent to issue Caste/Tribe certificates:
1. 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.
2. Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.
3. Revenue Officers not below the rank of Tehsildar.
4. Sub-divisional Officer of the area where the candidate and/ or his family normally reside(s).
5. Administrator / Secretary to Administrator / Development Officer (Lakshadweep Island).
6. Certificate issued by any other authority will be rejected.
 FORM-PwD (II)
Form-II
Disability Certificate
(In cases of amputation or complete permanent paralysis of limbs and in cases of blindness)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE
CERTIFICATE)
(See rule 4)

Recent PP size
attested
photograph
(showing face
Certificate No. only) of the person
Date:
with disability
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 am satisfied that:
1. he/she is a case of:
a. locomotor disability
b. blindness
(Please tick as applicable)
2. the diagnosis in his/her case is

3. He/ She has % (in figure) percent

(in words) permanent physical impairment/blindness in relation to his/her

(part of body) as per guidelines (to be specified).

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

Nature of Document Date of Issue Details of authority issuing certificate

(Signature and Seal of Authorised Signatory of notified Medical Authority)

Signature/Thumb impression of the person in

whose favour disability certificate is issued.
 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-PwD (IV)
Form-IV
Disability Certificate
(In cases other than those mentioned in Forms II and III)
(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 am satisfied
that he/she is a case of disability.
1. His/her extent of percentage of physical impairment/disability has been evaluated as per
guidelines (to be specified) and is shown against the relevant disability in the table below:

S. No. Disability Diagnosis Permanent physical impairment /

mental disability (in %)
1 Locomotor disability
2 Visual Impairment (blindness / low vision)
3 Hearing impairment
4 Speech and language disability
5 Intellectual disability
6 Mental-illness
7 Disability caused due to chronic eurological
conditions and / or blood disorders
(Please strike out the disabilities which are not applicable.)

2. The above condition is progressive/ non-progressive/ likely to improve/ not likely to improve.
3. Reassessment of disability is:
a. not necessary
Or
b. is recommended/after years months, and therefore this certificate
shall be valid till (DD/MM/YY)

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

Nature of Document Date of Issue Details of authority issuing certificate

(Authorised Signatory of notified Medical Authority)

(Name and Seal)

Countersigned
{Countersignature and seal of the CMO/Medical Superintendent/Head of Government Hospital, in case
the certificate is issued by a medical authority who is not a government servant (with seal)}

Signature/Thumb impression of the person in

whose favour disability certificate is issued.

Note: In case this certificate is issued by a medical authority who is not a government
servant, it shall be valid only if countersigned by the Chief Medical Officer of the District.
Note: The principal rules were published in the Gazette of India vide notification number
S.O. 908(E), dated the 31st December, 1996.