FOR RESERVATION OF JOBS FOR OTHER BACKWARD CLASSES IN CIVIL POSTS AND SERVICES UNDER GOVERNMENT OF INDIA / KERALA ..................................................... ...................................................... ....................................................... Sir, I request that a certificate in respect of reservation for other Backward classes in Civil Posts and under Government of India be granted to me. I give below the necessary particulars : 1. Full name of the applicant : (in Block Letter) 2. Date of Birth : 3. Complete Residential Address : (a) Present : (b) Permanent : 4. Religion : 5. Caste : 6. Sub-caste : 7. Occupational Group : 8. Serial Number of the Caste in the Central list of O.B.Cs. : 11. Name of Husband : 12. Status of Parent(s) / Husband : Father Mother Husband (A) Constitutional Posts : (i) Designation : (B) Government Services : Father Mother Husband (i) Service ( Central/State) : (ii) Designation : (iii) Scale of pay, including Classification, if any : (iv) Date of appointment to the post : (v) Age at the time of promotion to Class I Post (if applicable) : II Employment in International Organisation e.g. UII, UNICEF, WHO (i) Name of organisation : (ii) Designation : (iii) Period of Service (indicate date) : (from ........................................ ..................................................) III Death / Permanent incapacitation : (Omit if not applicable) (i) Date of Death/ permanent incapacitation Putting an officer out of service (ii) Details of permanent incapacitation : (C) Employment in Public Sector Undertaking etc (i) me of organisation (ii) Designation : (iii) Date of appointment to the post : (D) Armed force including paramilitary force (this will not include persons holding Civil Posts) (i) Designation : (ii) Scale of Pay (E) Professional Class (other than those covered in item Nos. B&C) and those engaged in Trade / Business, and Industry (F) PROPERTY OWNERS (i) Agricultural Holdings and plantations Vacant land and/or buildings in Urban Areas or Urban agglomeration (G) Income / Wealth (i) Annual family income from all sources (excluding salaries & income from agricultural land) : (ii) Whether Tax payer (Yes/No) (if yes a copy of the last three years return be furnished) : (iii) Whether covered in Wealth Tax Act (Yes/No) (If so furnish details) : Son (s) and daughter (s) of Persons/ Persons/Family having 5 hectares of more of agricultural holding/Plantations Criteria specified in Category VI below will apply Explanation -Building may be used for residential, industrial or commercial purpose and the like or two or more such purposes. (I) I certify that the above said particulars are true to the best of my knowledge and belief and that I do not belong to the Creamy Layer of O.B.Cs and am eligible to be considered for posts reserved for O.B.Cs. In the event of any information being found false or incorrect or ineligibility being detected before or after the selection, I understand that my candidature/ appointments is liable to be cancelled and I shall be liable to such further action as may be provided under the law and /or Rules. Yours faithfully Place................... Date.................... Signature of the Candidate.
