The Ethnology Of Beda Badaga Jangam Caste In Andhra Pradesh

certificate in the past by any authority, a copy
of such certificate should be furnished.

9. Community for which certificate is claimed
(including sub-tribe or sub-group)

10. a) Community of the father (including sub-tribe
or sub group)

b) Community of the mother (including sub-tribe
or sub group)

11. Whether the applicant is

a) a natural born son or daughter of his/her parents

OR

b) adopted son/daughter of his/her parents

DECLARATION

I/we declare that the information furnished by me/us in the application is true
and correct, and the documents appended thereto are genuine and the con-
tents of the documents are true and correct and that if these are found to be
untrue and incorrect, I/We will be liable for prosecution for furnishing false and
incorrect information/ documents under Section 10 of the Act No.16 of 1993.

Signature of the applicant
Signature of the Parent/Guardian
STATION:

DATED:

ACKNOWLEDGEMENT SLIP

Received an application for issue of Community, Nativity and Date of Birth Cer-
tificates relating to Scheduled Tribe in Form I, from...................(name of the

applicant/ parent/guardian) belonging to...............village/town.............mandal,

..................District on..................(date).

Signature of the Officer authorised
by the Competent Authority

(Name in capital letters)
and designation, (affix seal)
Name of the Office
Date:

FORM II

FORM OF APPLICATION FOR ISSUE OF COMMUNITY, NATIVITY AND
DATE OF BIRTH CERTIFICATES RELATING TO SCHEDULED CASTE/

BACKWARD CLASS UNDER SECTION 3 (1) OF ACT 16 OF 1993

(Information to be furnished by the applicant himself supported by

documentary evidence)

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