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Applicationdetails

This document is an online application form for a Scheduled Caste/Scheduled Tribe certificate, submitted by an applicant named Inu Limbu, who is applying for an ST certificate under the caste LIMBU. The application includes personal details such as the applicant's birth date, address, nationality, and contact information, along with declarations regarding the accuracy of the provided information. The form also requests details of referees and confirms that the applicant has not migrated from another state or country.

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Sanjeev Sarkar
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52 views1 page

Applicationdetails

This document is an online application form for a Scheduled Caste/Scheduled Tribe certificate, submitted by an applicant named Inu Limbu, who is applying for an ST certificate under the caste LIMBU. The application includes personal details such as the applicant's birth date, address, nationality, and contact information, along with declarations regarding the accuracy of the provided information. The form also requests details of referees and confirms that the applicant has not migrated from another state or country.

Uploaded by

Sanjeev Sarkar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

FORM IA

SEE RULE 7BB[I]


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,
Siliguri , Darjeeling.
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 : STWB01042024/2813 ( Block : Naxalbari )
1. (a) Applying for : ST (b) Name of caste : LIMBU
2. Full Name of Applicant : INU LIMBU
: Father's Name
3. : NARESH LIMBU 5. Contact No. : 8670621114
4. (a) Date of Birth : 10/07/2012 6. Email Id. :
(b) Place of Birth : 7. Aadhaar No. : XXXXXXXX7417
Village / Ward Police Station District State
MES COLONY, KOLATA ROAD BAGDOGRA INVES.CNTRE DARJEELING WEST BENGAL

8. Address since birth (a) Present address:


Para / House No. / Ward No. / G.P. Post Office Police Station District State PIN
Road / Village
MES COLONY, UPPER BAGDOGRA BAGDOGRA BAGDOGRA DARJEELING WEST 734014
KOLATA ROAD INVES.CNTRE BENGAL
(b) Other address(s) :
Para / House No. / Road / Village Ward No. / G.P. Post Office District State PIN
MES COLONY, KOLATA ROAD UPPER BAGDOGRA BAGDOGRA DARJEELING WEST 734014
BENGAL

9. Nationality : INDIAN 10. Religion : Hinduism 11. Sex : Female


12. Whether any of the blood relations of the applicant posseses Caste Certificate? No
If answer to point no. 12 is 'Yes':
Name of cert. holder Relation with applicant Certificate No. Date of Issue Issuing authority

13. Details of two(2) referees:


Name of 1st referee Address of 1st referee Name of 2nd referee Address of 2nd referee
NARESH LIMBU MES COLONY, KOLATA ROAD MANILA LIMBU MES COLONY, KOLATA
ROAD
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: ( Signature of applicant / gurdian in case of minor )

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