FORMAT FORM OF APPLICATION FOR OBTAINING SCHEDULE TRIBE CERTIFICATE FROM THE DEPUTY COMMISSIONERS 1. Name in full (In block letter) ................................................................... 2. Date of Birth ................. 3. Name of Tribe .................. 4. Father's detail: Name ................................................. Village ............................................................. 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 knowledge, belief and information. I bind myself to legal action in the particulars found incorrect. Place & Date ............................................. SIGNATURE OF THE APPLICANT IN CASE, IF MINOR-GUARDIAN In case the applicant is minor, applicant is to be signed by Parents or Guardian, if parents are not alive. VERIFICATION Certified that both the parents of Shri / Smti / Miss ................................................. is a bonafide APST Tribe ..................................................................... and thereby said applicants a bonafide. (Mention the tribe) Schedule Tribe of Village ..................................... Circle ................................... District ............................................. I have verified the above particulars and found correct. SIGNATURE RECOMMENDATION OF VILLAGE COUNCIL PANCHAYAT FOR SCHEDULED TRIBE CERTIFICATE Shri / Smti / Miss .......................son / daughter / wife ......... is known to me since last .........years and he/she is permanent resident of ............... Village under ............... Circle, .......... District, arunachal Pradesh. (SIGNATURE OF HGB / GPM / ASM / ZPM/ VP) Village........ RECOMMENDATION OF THE ADMINISTRATIVE OFFICER ............................. ................................... ................................... ................................... Certified that the above particulars furnished by the applicant is correct to the best of my knowledge and belief. Recommendation of the concerned Administrative officer of the Area.
