Annexure ‘D’

Certificate for Scheduled Caste

It is certified that Shri/Shrimati/Kumari __________________________________

son/daughter/wife of Shri ____________________________________________

of village/town ____________________________________________________

District/Division ___________________________________________________

State of Punjab belongs to ________________________________ Caste which

has been recognized as Scheduled Caste as per the constitution (Scheduled

Castes), Order 1950.

2. Shri/Shrimati//Kumari _____________________________________________

and his/her family lives in village/town _________________________________

District/Division ______________________________________ of Punjab State.

Place ___________________ Signature

Designation
Date ___________________ Seal of Office