FORMAT FORM OF APPLICATION FOR OBTAINING SCHEDULE TRIBE CERTIFICATEFROM THE DEPUTY COMMISSIONERS 1. Name in full (in block letter) 2. Date of Birth 3. Name of Tribe 4. Father's details : Name Village Village Circle Circle Sub - Division District 5. Mother's details : Name Whether Mother is APST or Non APST If APST, Name of tribe 6. Permanent address of the applicant : Village Circle Sub - Division District 7. Present Address : Post Office Police Station Sub - Division District 8. Religion 9. Nationality 10. Occupation if any 11. Purpose for which certificate is asked for 12. Whether such certificate was obtained earlier, if yes give details SIGNATURE OF THE APPLICANT DECLARATION I solemnly affirm that the particulars given in the above application are correct to the best of my knowlege,belief and information. I bind myself to legal action if the particulars found incorrect. Place & Date SIGNATURE OF THE APPLICANT In case the applicant is minor, application is to be signed by Parents or Guardian (if parents are not alive). RECOMMENDATION OF VILLAGE COUNCIL PANCHAYAT FORSCHEDULED TRIBE CERTIFICATE Shri / Smti / Miss years son / daughter / wife of is konwn to me since last and he / she is permanent resident of Village under Circle District, Arunachal Pradesh. ( SIGNATURE OF HGB / GPM / ASM / ZPM / VP ) Village VERIFICATION Certified that both the parents of Shri / Smti / Miss is a bonafide APST Tribe and thereby said applicant a bonafied Schedule Tribe of Village Circle District I have verified the above particulars and found correct. SIGNATURE RECOMMENDATION OF THE ADMINISTRATIVE OFFICER _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Certified that the above particulars furnished by the applicant is correct to the best of my knowlege and belief Recommendation of the concernedAdministrative officer of the Area
