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State of Chattisgarh - Act

Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013

CHHATTISGARH
India

Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013

Rule CHHATTISGARH-SCHEDULED-CASTES-SCHEDULED-TRIBES-AND-OTHER-BACKWARD-CLASSES-REGULATION-OF-SOCIAL-STATUS-CERTIFICATION-RULES-2013 of 2013

Published on 2 September 2013
Commenced on 2 September 2013
[This is the version of this document from 2 September 2013.]
[Note: The original publication document is not available and this content could not be verified.]

Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013Published vide Notification No. F13-23/2012/R.C./1-3, dated 2.9.2013Last Updated 17th September, 2019Notification No. F13-23/2012/R.C./1-3 dated the 2nd September, 2013. - In exercise of the powers conferred by Section 19 of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013 (No. 13 of 2013), the State Government, hereby makes the following Rules, namely : -

Chapter I
Preliminary

1. Short title and Commencement.

(1)These rules may be called the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013.

(2)These rules shall come into force from the date of their publication in the Official Gazette.

2. Definitions.

(1)In these rules, unless the context otherwise requires, -

(a)"Act" means the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013 (No. 13 of 2013);

(b)"Applicant" means a person, applying for Certificate in prescribed manner, verification of Certificate, a person whose Certificate is to be verified as decided by the District Level Certificates Verification Committee, or a person whose employer, educational institution, local authority, the Central Government or the State Government, as the case may be, has referred his Certificate to the District Level Certificate Verification Committee for verification;

(c)"Application" means an application under these rules;

(d)"Certificate" means a Social Status Certificate as defined under clause (o) of Section 2 and issued under sub-section (1) of Section 4 of the Act;

(e)"Date of Presidential Notification" means with reference to Scheduled Castes notification dated 10th of August, 1950 and with reference to Scheduled Tribes notification dated 6th of September, 1950,

(f)"Migrants from other States" means the person migrating into the geographical area of State of Chhattisgarh from other State or Union Territory after the Date of Presidential Notification or Notification Date of Other Backward Class or who has been born after the Date of Presidential Notification or the Notification Date relating to Other Backward Class, as the case may be :

Provided that his father or legal guardian must have migrated into the geographical area of State of Chhattisgarh after the Date of Presidential Notification or Notification Date relating to Other Backward Class, as the case may be;

(g)"Non-Applicant" means the employer or educational institution or local authority, the State Government or the Central Government, as the case may be, which has referred the Certificate of Applicant to the verification committee for verification;

(h)"Notification Date of Other Backward Classes" means 26th of December, 1984;

(i)"Notification of State Government regarding Other Backward Class" means the order issued by the Governor or notified list of Other Backward Classes, in connection with State of Chhattisgarh, as amended from time to time;

(j)"Prescribed" means prescribed under these rules;

(k)"Presidential Notification" means order issued by the President under Article 341 and Article 342 of the Constitution of India with respect to the State of Chhattisgarh, and as amended by the Parliament from time to time;

(l)"Provisional Social Status Certificate" means a Social Status Certificate issued in FORM-4B under Rule 10;

(m)"Relative" means related by blood from the side of applicant's paternal family;

(n)"Resolution of the Gram Sabha" means any declaration, conclusion, decision or a resolution of Gram Sabha of the village where applicant is domiciled, in connection to the social status of the applicant, so as to clear the social status of the applicant unambiguously;

(o)"Scrutiny Committee" means High Power Certification Scrutiny Committee constituted under sub-section (1) of Section 7 of the Act for scrutiny of Certificate;

(p)"Verification Certificate" means the certificate, issued by the District Level Certificates Verification Committee, validating the Certificate issued by the Competent Authority;

(q)"Verification Committee" means District Level Certificates Verification Committee constituted in a District under sub-section (1) of Section 6 of the Act for verification of Certificate issued to applicants.

(2)Words and expressions not defined in these rules shall have the same meanings as defined under the Act.Chapter-II Issuing of Social Status Certificate

3. Application for issuance of Certificate.

(1)The applicant in order to obtain Certificate on permanent basis, shall submit an application to the Competent Authority in FORM-1 A.

(2)Applicant shall submit his application to the Competent Authority in person or through post or Choice Centre or a Common Service Centre.

(3)Applicant shall submit along with application following documents, namely : -

(a)An Affidavit in FORM-2A, in original;

(b)Family tree of the applicant starting from last three generations, duly issued by the Halka Patwari;

(c)Document or self attested copy of the document verifying that his ancestors were residing in the geographical limits of the State of Chhattisgarh on or before the Date of Presidential Notification or Notification Date relating to Other Backward, Class, as the case may be;

(d)In cases where applicant is an officer/employee allocated to Chhattisgarh State Cadre or their children, in compliance, of Section 67 of Madhya Pradesh Reorganisation Act, 2000 (No. 28 of 2000), principles laid down in Para (1) and (2) of the Notification dated 23-9-2007 of State Reorganization Cell. Such document or duly attested copies of documents, verifying that -

(i)ancestors of the applicant were residing in the geographical limits of the then State of Madhya Pradesh before or on the Date of Presidential Notification or Notification Date relating to Other Backward Classes, as the case may be;

(ii)they have been allotted to Chhattisgarh State Cadre under Section 67 of the Madhya Pradesh Reorganisation Act, 2000 (No. 28 of 2000).

(e)Any of the following document or self attested copy showing caste of the applicant's father or ancestor, namely : -

(I)Revenue document of ancestors (case, file);

(II)Jama-Bandi (Survey) or Girdawari;

(III)State Settlement;

(IV)Document of Rights (1954);

(V)Census (1931);

(VI)Survey of Forest Department;

(VII)National Register of Citizens (1949);

(VIII)Register of Birth or Death;

(IX)Admission Register (Dakhil/Kharij), in case father or ancestors were literate;

(X)Caste Certificate, issued earlier to Father, Ancestor or a relative;

(XI)Resolution passed by the Gram-Sabha regarding caste of the applicant where no documentary evidence in proof of caste is available;

(f)Income certificate of preceding year of applicant's father in case of Other Backward Class Applicant;

(g)Envelope having appropriate postage stamp and legible address.

(4)The applicant shall submit original certificates and documents, at the time of verification or whenever required, before the Competent Authority. District level Certificate Verification Committee or Scrutiny Committee, as the case may be.

4. Registration of Application.

- The Competent Authority on receipt of the application shall register the application in a register, prescribed in FORM-5A

5. Preliminary Inquiry of the Application, Receipt and Return Memo.

(1)After registering application, the Competent Authority shall make a preliminary inquiry summarily, to ascertain whether the application is complete or not and whether document required under sub-rule (3) of Rule 3 are annexed or not. In case, the Competent Authority finds that the required document is annexed with the application, he shall, make available to the Applicant receipt prescribed in FORM-3A and in case required documents are not annexed shall give to the Applicant a Return Memo in FORM-3B within 7 days of the receipt of application.

(2)Counterfoil of the Receipt or Return Memo, as the case may be, shall be kept in the office of Competent Authority.

6. Inability Memo.

(1)An applicant belonging to Scheduled Castes or Scheduled Tribes, who has applied for obtaining Certificate, inspite of adequate efforts could not get the required document under sub-rule (3) of Rule 3, may give an affidavit about his inability to submit such document in prescribed FORM-3C, printed on the back of Return Memo.

(2)On receipt of Inability Memo, the Competent, Authority shall not demand for the required document or documents under sub-rule (3) of Rule 3 and shall proceed to inquire the claim of the applicant under Rule 8:Provided that the applicant shall present himself during such inquiry before the Competent Authority or before the inquiry officer indicated by him and shall give all necessary assistance to ensure the presence of related persons, so as to prove his claim of social status.

7. Inquiry Officer.

- Competent Officer, within fifteen days from the date of receipt of such application shall either proceed to inquire himself or shall direct a subordinate Revenue Officer for Inquiry.

8. Inquiry.

(1)The Inquiry Officer, shall inquire about the residence, permanent address, revenue records, immovable property, occupation of applicant's family, name in voter list and other evidence, which are relevant to prove the permanent residence on the Date of Presidential Notification or Notification Date relating to Other Backward Classes, as the case may be, and shall verify the social status claimed by the Applicant.

(2)The Competent Authority may, apart from documents mentioned in sub-rule (3) of Rule 3, inquire into documents of local bodies, for example, of Gram Panchayat, Janpad Panchayat, Zila Panchayat, Nagar Panchayat, Municipality and Municipal Corporation also.

(3)Inquiry officer may also record oral statements, as evidence, of village Kotwar, Village Sarpanch, Halka, Patwari, local ward member, other public representatives of the area, gazetted officers residing in the locality, other local members of that caste already having Certificate and knowing the applicant properly.

(4)Inquiry officer, where he is not a Competent Officer, after inquiry shall furnish his written Report having clear outcome, along with documentary evidence and recorded oral statements to the Competent Authority, within fifteen days of receiving inquiry orders.

9. Social Status Certificate.

- The Competent Authority after receiving application under sub-rule (1) of Rule 3 and conducting an inquiry under Rule 8 and in case where himself is not an inquiry officer, after satisfying himself with the annexed documents and Report of the inquiry officer, within one month from the date of receipt of application, shall issue the certificate in FORM-4A (1) to the Applicant of Scheduled Castes, in FORM-4A (2) to the Applicant of Scheduled Tribes and in FORM-4A (3) to the applicant of Other Backward Classes.

10. Provisional Certificate.

(1)For the purpose of granting admission to educational institutions upto tenth standard or for granting scholarship or stipend at such level or for such other purposes, where large numbers of Certificates are necessary and it is not feasible to issue such Certificate well in time, the Competent Authority, may issue a provisional certificate in FORM-4B on the basis of affidavit given by the applicant in FORM-2A within fifteen days from the date of application :Provided that the Competent Authority shall maintain the details of provisional certificates issued in FORM-5B.

(2)The provisional Certificate shall be valid only for a period of six months or till the date of issue of permanent Certificate, whichever is earlier.

11. Certificate for the Applicant migrated from other State to the State of Chhattisgarh.

- In case, where the Applicant is a migrant from other States, Competent Officer shall issue a certificate in FORM-4C, after marking detailed inquiry, if necessary, through the District Magistrate or Verification Committee or through Vigilance Cell, regarding his social status in that State:Provided that such certificate holder shall be eligible to avail the facilities provided to Scheduled Castes, Scheduled Tribes or Other Backward Classes, as the case may be, in that State from which he has migrated.

12. Involuntary Migration.

- Government employees of undivided Madhya Pradesh and such other officers and employees of Corporation, Commission, Board and Public Undertakings, who have been allocated to the State of Chhattisgarh due to division of cadres between State of Madhya Pradesh and State of Chhattisgarh under Madhya Pradesh Reorganization Act, 2000 (No. 28 of 2000) such employee and his family members, if they belong to Scheduled Castes or Scheduled Tribes or Other Backward Classes in the State of Chhattisgarh shall be deemed to have been migrated involuntary from the State of Madhya Pradesh to the State of Chhattisgarh and they shall be issued Certificate and shall be given benefits of reservation in the State of Chhattisgarh.

13. Certificate, document register.

- Details of Certificate issued by the Competent Authority shall be kept in FORM-5C.Chapter-III Verification of Certificate

14. Constitution of District Level Certificates Verification Committee.

(1)The State Government shall constitute District Level Certificates Verification Committee having jurisdiction over one or more districts, for the verification of certificates issued by the Competent Authority, as under: -

(a)	Additional Collector or Deputy Collector postedat District Headquarters, nominated by Collector;	- Chairman
(b)	One Officer not below the rank of Class II,belonging to Scheduled Tribe, nominated by Collector;	- Member
(c)	One Officer not below the rank of Class II,belonging to Scheduled Caste, nominated by Collector;	- Member
(d)	One Officer not below the rank of Class II,belonging to Other Backward Class, nominated by Collector;	- Member
(e)	A subject expert officer or Class III executiveemployee, nominated by Director, Tribal Research and TrainingInstitute;	- Member
(f)	Assistant Commissioner, Scheduled Tribe andScheduled Caste Development Department.	- Member-Secretary

(2)In case on the post of Subject Expert Officer or Class III executive employee, an appropriate officer or employee is not available for the Verification Committee then the Director, Tribal Research and Training Centre Institute, Raipur may appoint any retired officer or a Class III executive employee as member.

(3)For the nominated retired Subject Expert Officer or Class III executive employee in the Verification Committee, honorarium shall be determined by the State Government.

(4)Meetings of the Verification Committee, as required shall be held on a fixed day, every week :But the meeting of the Committee may also be convened on the direction of Chairman on a short notice of one day.

15. Verification of Certificate and reference to Verification Committee.

(1)If the concerned public employer, educational institution or a statutory body the State Government or the Central Government, as the case may be, receives a complaint or raises a doubt that the person appointed, admitted, elected, named or nominated has obtained Certificate wrongly or fraudulently then he/it shall ask such person to file an affidavit in FORM-2B and shall refer the matter to the Verification Committee in FORM-IB.

(2)Verification Committee shall verify about 10% of the total number of Certificates issued by the Competent Authority, as sample inquiry through random sampling method. The Applicant shall not be at liberty to seek information from the Verification Committee as to why his certificate has been selected for verification.

(3)Verification Committee may direct any Applicant to submit application in F0RM-1C along with affidavit in FORM-2C and shall exhibit such document as required under sub-rule (3) of Rule 3, necessary to verify his social status.

(4)A Non-Applicant, instead of referring a certificate to the Verification Committee may also direct the Applicant to get his certificate verified by the Verification Committee. In such cases the Applicant shall submit his original certificate, an application in FORM-1C along with affidavit in FORM-2C and document as required under sub-rule (3) of Rule 3.

(5)In case of direction from Verification Committee under sub-rule (3) or direction from Non-Applicant under sub-rule (4) to verifying Certificate from the Verification Committee, the Applicant shall be bound to submit the application as mentioned above along with affidavit and documents as required under sub-rule (3) of Rule 3 within a period of not more than a month, failing which the committee may decide ex-parte and Certificate of such Applicant shall be forwarded under Rule 18 to Scrutiny Committee:Provided that where applicant satisfies the Verification Committee that application, affidavit and other documents could not be submitted within prescribed time limit of one month, due to adequate reasons, the Verification Committee may extend the time for the verification of certificate of the applicant.

16. Registration of application by the Verification Committee.

(1)Verification Committee shall register the applications for verification received from Applicant or Non-Applicant in a register as prescribe in the FORM-5D.

(2)Verification Committee shall send receipt in FORM- 3D to the Applicant or Non-Applicant, as the case may be, within 7 days of the receipt of application.

17. Verification of Certificate by Verification Committee.

(1)The Verification Committee on being satisfied with the application and documentary evidence annexed therewith shall issue verification certificate in FORM-4D(l) to Scheduled Castes, in FORM-4D(2) to Scheduled Tribes and in FORM-4D(3) to Other Backward Classes to the Applicant, his guardian or Non-Applicant, as the case may be, within a period of not more than one month :Provided that if the Applicant, his guardian or Non-Applicant, as the case may be, requests to send the same by post, the committee may send the same by registered post.

(2)Verification Committee shall maintain details of the verified Certificates in FORM-5E.

18. Procedure where Verification Committee is not satisfied with the documentary evidence.

(1)Where the Verification Committee is not satisfied with the documentary evidence annexed with Application, it may, within fifteen days from the date of receipt of application or within fifteen days of reference by Non-Applicant shall inform the Applicant or Non-Applicant, if any, stating the reasons of non-satisfaction thereby and shall give the Applicant, any opportunity to be heard:Provided that the Verification Committee shall complete hearings in not more than three months and in case where the Committee is of opinion that the Certificate seems to have been obtained wrongly or fraudulently it shall forward the original certificate along with relevant documents and its findings to the Scrutiny Committee for inquiry under Rule 20 and shall also inform the Applicant and Non-Applicant, if any.

(2)Verification Committee shall maintain details of forwarded certificates to the Scrutiny Committee in FORM-5F.

Chapter IV
Inquiry, Cancellation and Forfeiture of Certificates

19. Registration of the Cases by High Power Certification Scrutiny Committee.

(1)The Higher Power Certification Scrutiny Committee shall register the referred cases by Verification Committee or by the State Government or by the State Government in FORM-5G.

20. Inquiry of the Case through Vigilance Cell.

(1)The Scrutiny Committee shall forward the Certificate and copies of all relevant documents in cases referred to it by Verification Committee or by the State Government or any other authority in FORM-6A to the Vigilance Cell constituted under Deputy Superintendent of Police;

(2)The Deputy Superintendent of Police through subordinate Police Inspector shall inquire into the case and inform Scrutiny Committee accordingly;

(3)Police Inspector of Vigilance Cell shall -

(a)search places of local residence, domicile and general residence of Applicant or the city, town or village of his origin before migration;

(b)ascertain the truth regarding the Social Status as claimed by the Applicant or his parents or his Guardian, as the case may be, on the basis of public documents;

(c)verify the information stated in the application submitted to Verification Committee by the Applicant on the basis of relevant public documents and reliable private documents;

(d)obtain information from Village Kotwar, Village Sarpanch, Halka Patwari, Local Ward Member, Other Public Representatives, Local Gazetted Officers, such local members already having a Certificate and who are knowing well the Applicant and if any of them agrees to record his oral statement then he shall record his statement accordingly or shall request important witnesses to give their statement on oath and in case they agree, shall obtain the affidavit accordingly and give a copy of the same to the witness concerned;

(e)give an opportunity to the Applicant himself and parents of the Applicant and shall record the statement of witnesses indicated by them or shall obtain their affidavits;

(f)if during the examination it is found that the Applicant or any other person has maliciously forged the document, after getting the photocopy of the relevant pages, seize the document with the help of local police and shall seal and send the document to Deputy Superintendent of Police of Vigilance Cell and shall give a receipt and copy, to the authorities having custody of the documents;

(g)submit his report along with all documents to the Deputy Superintendent of Police after completing the investigation.

(4)Deputy Superintendent of Police, after obtaining necessary permission of the Scrutiny Committee shall send the document seized by the Police Inspector for forensic test and to handwriting expert along with appropriate noting.

(5)The Deputy Superintendent of Police shall submit the Inquiry Report containing his clear opinion regarding social status of the Applicant, alongwith documents received from Police Inspector and conclusions of forensic and handwriting expert to the Scrutiny Committee.

(6)The Scrutiny Committee shall examine such report and in case it finds any deficiency in the report shall revert the same to the Vigilance Cell after indicating such deficiency and may direct for inquiry on specific issues.

(7)Police Inspector and Deputy Superintendent of Police shall maintain details of above mentioned investigation of the cases in FORM-5H.

21. Action on the Report of Vigilance Cell.

(1)If in the Inquiry Report of Vigilance Cell, claims regarding social status of the Applicant has been reported as just and proper then there shall be no further action needed by the Scrutiny Committee and it shall intimate accordingly to the concerned Verification Committee or the State Government, as the case may be, and to the Applicant.

(2)If the matter is referred by the State Government, the case shall be filed/closed at the State Government level with intimation to the Applicant and if the matter has been referred by the Verification Committee, then the Verification Committee after due verification in the manner provided under Rule 17 shall send the Original and Verified Certificate to the Applicant or Non-Applicant, as the case may be.

22. Inquiry by High Power Certification Scrutiny Committee.

(1)Where the Scrutiny Committee is not satisfied with the social status claim of the Applicant, according to the inquiry Report of the Vigilance Cell the committee may through registered post shall issue a show-cause notice to Applicant in prescribed FORM-6B along with report of the Vigilance Cell and the copy of such notice shall also be given to the Non-Applicant (if any) also.

(2)After receiving the reply of the Applicant, the Scrutiny Committee shall convene a meeting wherein it shall direct the Applicant to produce his/her Certificate in original and Applicant shall be given adequate opportunity of hearing and producing evidence.

(3)The Scrutiny Committee shall also issue a public notice regarding the hearing, which shall be widely publicized in the village or announced by beat of drum, advertisement or through some other convenient means, so that any person or institution may support or oppose the applicant's claim and such person or institution shall also be accorded an opportunity of hearing and producing evidence, if any.

(4)After giving reasonable opportunity of hearing to the Applicant or to his guardian (in case the applicant is not an adult), Scrutiny Committee may conduct such inquiry, so as to consider the claim and other objections.

(5)Scrutiny Committee may send the notice or summons for service to the Teshildar, Additional Tehsildar, Nayab Tehsildar, who shall serve the notice in the manner as directed in FORM-6C.

23. Decision of the Scrutiny Committee and proceedings thereafter.

(1)After hearing both the sides in support and against the claim, the Scrutiny Committee on being satisfied with regarding the genuineness of the claim of the Applicant shall direct the concerned Verification Committee to issue Verification Certificate, if applied so.

(2)If after hearing the Applicant regarding his claim of Social Status Certificate the Scrutiny Committee, comes to the conclusion that the claim of the Applicant is not genuine, it may pass a reasoned order and cancel the Certificate.

(3)The Scrutiny Committee while passing order under sub-rule (2) shall authorise an officer of the employer, educational institution, local authority, the Central Government or the State Government to file complaint under sub-section (2) of Section 10 of the Act and forward attested copies of all documents related to the case to such officer for further proceedings.

(4)The Scrutiny Committee while passing order under sub-rule (2) of this Rule shall issue instruction to the concerned Collector to investigate, whether the Competent Authority knowingly or having knowledge that such certificate was false has issued such False Social Status Certificate or any other person has abetted such offence and Collector shall forward his report to the State Government, within three months.

(5)The Scrutiny Committee after passing the order of cancellation of False Social Status Certificate shall confiscate it and details shall be entered in the register as prescribed in FORM-51 and such Certificate shall be impressed as "Cancelled and Confiscated".

(6)Copies of the order passed by the Scrutiny Committee shall be sent to the Non-Applicant, if any, and to the Applicant by registered post immediately after passing such order. If the Applicant or any other person present in the office demands copy of the order, the same shall be supplied to the person on payment of appropriate fee.

24. Action against false Certificate holder.

- The officer of the public employer, educational institution or a statutory body, the State Government or Central Government as the case may be, who is authorised by the Scrutiny Committee shall on the basis of the attested copy of the decision passed by the Scrutiny Committee, shall file a written complaint in the Police Station under sub-section (1) of Section 154 of Criminal Procedure Code, 1973 (Act No.2 of 1974) against the said False Social Status Certificate holder.

25. Action against the abettor and Competent Authority issuing False Social Status Certificate.

- The Collector of the concerned district shall file written complaint against the Competent Authority issuing False Social Status Certificate and the abettor of the offence.

Chapter V
Miscellaneous

26. Procedure for issuing duplicate of Certificate and Verification Certificate.

- Where an original certificate or verification certificate relating to an Applicant has been lost or stolen or destroyed due to natural calamities like floods, earthquake etc. or on request and after depositing fee as prescribed by the State Government, Competent Authority or Verification Committee as the case may be, may issue the duplicate on the basis of original document kept in such office. There shall be a clear mention of "Duplicate Copy' on such Certificate or Verification Certificate.

27. Notice regarding Issuance, Verification or Cancellation of Certificate.

(1)Competent Authority, Verification Committee and Scrutiny Committee, as the case may be, shall display the information regarding issuance, verification or cancellation of Certificate every month, before the Fifth day of the month on the office Notice Board and shall also send the information to local autonomous institutions and bodies, municipal corporation, municipality, village panchayat etc. for their records and shall also send the information through District Information Centres, in order to display it on ascertained website.

(2)Competent Authority shall also send the information regarding issue of certificate and cancellation of applications, every year by 31st December to the State Government, in prescribed FORM-7 A.

(3)Verification Committee shall send the information regarding verification of certificates, cancellation of application, cases forwarded to Scrutiny Committee every year by 31st December to the State Government, in prescribed FORM-7B.

(4)Scrutiny Committee shall send the information regarding inquiry on the complaints referred by the State Government and Verification Committees and cancellation of Certificate, every year by 31st December to the State Government in prescribed FORM-7C.Form-1A[See Rule 3(1)]Application For Social Status CertificateTo,Competent Authority,Sub-Division.............District...........................Sir,I beg to state that in order to avail facilities given to Scheduled Castes/Scheduled Tribes/Other Backward Classes, I/my son/daughter requires Certificate of Social Status. In this connection following information is being submitted, namely : -

1.	Name of the Applicant	:	.......................
2.	Father's Name of the Applicant	:	.......................
3.	Applicant's marital status :	:	Married/Unmarried
4.	Name of the Husband (in case of femaleapplicant)	:	.................
5.	Date of Birth of Applicant	:	................
6.	Caste (For SC only)	:	.....................
7.	Present Address in full	:	Mohalla/Ward.............
			Village/Town/City........
			Block............Tehsil........
			District.................
			State....................
8.	Permanent Address in full	:	Mohalla/Ward.............
			Village/Town/City........
			Block............Tehsil.........
			District.................
			State....................
9.	Applicant's Date of Birth
	(a) if before 10/08/50 for SC and 6/9/50 for ST;		Mohalla/Ward...........
			Village/Town/City......
	(b) if before 26/12/84 for OBC then, place ofbirth of applicant; or if after these dates then permanentresidential address of his Father/ Ancestor		Block...........Tehsil......
			District.................State.............
10.	Head of the Family residing on theabove-mentioned address on the above-mentioned date	:	Name.......................... Relation with theApplicant..........
11.	Details of the places where the Applicant/hisfather/ancestors have stayed from 10-8-1950 (with respect to SC),6-9-1950 (with respect to ST) and 26-12-1984 (with respect toOBC) till the present day	:	..................
12.	Applicant's Caste/Tribe (including sub-caste)	:	............
13.	Whether it is prescribed for the State or theDistrict vide Notification dated 26-12-1984, as amended for OBCunder Madhya Pradesh Reorganisation Act, 2000 ? If yes, itsserial number	:	.......................
14.	Attach attested copies of the followingdocuments :		Details of the attached documents
	(1) Below-mentioned documents ofApplicant's/father/ancestors mentioning their caste : -
	(a) Revenue document of ancestors (case file);
	(b) Jama-Bandi (Survey) or Girdawari B1;
	(c) State Settlement; OR
	(d) Document of Rights (1954); OR
	(e) Survey of Forest Department/Forest RightsCertificate; OR
	(f) Admission Register of educationalinstitution; OR
	(g) Register of Birth or Death; OR
	(h) National Register of Citizens (1949); OR
	(i) Copy of Caste Certificate, issued earlier toFather, Ancestor or a relative; OR
	(j) Census (1931).
	(2) Such domicile certificate or any otherdocument verifying that ancestors of the applicant were residingin the geographical limits of Chhattisgarh before the date10-8-1950 (Scheduled Castes), 6-9-1950 (Scheduled Tribes) or6-12-1984 (Other Backward Classes);
	(3) Family Tree commencing from ancestors toCaste certificate holder as obtained by Patwari.		Yes/No
	(4) If applicant's father is/were an employee ofState Government and in relation to SC/ST/OBC, before dated10-8-1950, 6-9-1950, 26-12-1984 where resident of existing Stateof Madhya Pradesh and were allocated to the State of Chhattisgarhon State Reorganization, related documents		Yes/No
	(5) If the applicant belongs to OBC and hisfather/mother is a government employee, document verifying theirpost and income certificate or copy of Form 16 of the precedingfinancial year		Yes/No
	(6) Envelope having full and legible address ofthe Applicant bearing adequate postage stamps (in case thecertificate is desired through post)		Yes/No
	(7) Affidavit of the Applicant (prescribed inFORM-2A).		Yes/No

I hereby solemnly affirm that the information contained in the application is true and correct to the best of my knowledge and belief.

Place:	(Applicant's Signature)
Date:

Form-1B[See Rule 15(1)]Office of the........

Sl. No. .....................

Date ..............................

To,ChairmanDistrict Level Certificates Verification CommitteeDistrict.............. Chhattisgarh.Sub. : Verification of Social Status of Shri/Smt./Ku................S/o/D/o/ W/o, ......................, resident of.............reg.Ref. : Social Status Certificate No................, dated........, issued by Competent Authority...............District..............Sir,Shri/Smt./Ku..............., S/o,/D/o,W/o,...........resident of..................,was appointed/admitted/elected/selected against posts/seat reserved for Scheduled Castes/Scheduled Tribes/Other Backward Classes in this institution/ local authority/department on the basis of Social Status Certificate No............... dated.........., issued by Competent Authority,..................District.............

2. On receiving a complaint that the Certificate has been wrongfully or fraudulently obtained, it is hereby decided to get the above Certificate verified by the District Level Certificates Verification Committee.

3. Original/Attested copy of the Certificate of Shri/Smt./Ku..................is enclosed herewith. Kindly verify the above Certificate in prescribed manner and time and report the findings to this office.

4. If Committee finds any prima-facie evidence, that the above Social Status Certificate was obtained wrongfully or fraudulently, kindly intimate, so that the concerned applicant may be directed to produce before you evidences in support of his claim.

Encl.: As above (Original/Attested copy of Social Status Certificate)Signature Name and SealForm-1C[See Rule 16(3 & 4)]Application before District Level Certificates Verification CommitteeTo,The Chairman,District Level Certificates Verification Committee..................................................Sub. : Regarding Verification of Scheduled Castes/Scheduled Tribes/Other Backward Classes Certificate.Sir,I, the undersigned................., Father/Husband's Name.................... Post................... Department...............hereby present the Social Status Certificate (original/copy) of Mr/Mrs/Ms.....................(Applicant's Name), Husband/Father's Name................for verification according to the guidelines of Verification Committee/Non-Applicant................(Public Planner/ Educational Institution/ Constitutional Unit/State Government/Central Government). I attach the following documents for the verification of claim of Mr./Mrs./Ms..................

1.	Applicant's name and surname	:	..............................................................................
2.	Name and surname of Father of the Applicant	:	..............................................................................
3.	Name and Surname of Father's father (PaternalGrandfather) of the Applicant	:	..............................................................................
4.	Name and surname of Mother of the Applicant	:	..............................................................................
5.	Name and Surname of Mother's father (MaternalGrandfather) of the Applicant	:	..............................................................................
6.	If Applicant is a lady, her Husband's name andSurname	:	..............................................................................
7.	Applicant's Date of Birth	:	..............................................................................
8.	Place of Residence	:	..............................................................................

S. No.	Place of Residence	Mohalla/ Ward number	Village/Town/City	Tehsil	District and State	Date or Year of Residence
1.	Applicant's present place of residence
2.	Applicant's place of residence in State ofChhattisgarh
3.	If Applicant's Date of Birth is on or before10-8-1950 (SC)/ 6-9-1950 (ST)/26-12-1984 (OBC), then His/Herpermanent address on such date
	If Applicant's Date of Birth is after 10-8-1950(SC)/ 6-9-1950(ST)/ 26-12-1984 (OBC), then His/HerFather/Ancestor's permanent address on such date
4.	Place of Residence of Applicant's Father inChhattisgarh State
5.	Permanent address of Applicant's PaternalGrandfather Residence

Educational Information

..............................................................................

S. No.	Applicant's Educational Information	Primary	Secondary	Higher Secondary	University
(1)	(2)	(3)	(4)	(5)	(6)
1.	Year of Education
2.	Name of Institution
3.	Village/City/State
4.	Block/Tehsil
5.	District/State

S. No.	Educational Information of Applicant's Father	Primary	Secondary	Higher Secondary	University
(1)	(2)	(3)	(4)	(5)	(6)
1.	Year of Education
2.	Name of Institution
3.	Village/City/State
4.	Block/Tehsil
5.	District/State

S. No.	Educational Information of Applicant's Mother	Primary	Secondary	Higher Secondary	University
(1)	(2)	(3)	(4)	(5)	(6)
1.	Year of Education
2.	Name of Institution
3.	Village/City/State
4.	Block/Tehsil
5.	District/State

S. No.	Educational Information of Applicant'sFather's Father	Primary	Secondary	Higher Secondary	University
(1)	(2)	(3)	(4)	(5)	(6)
1.	Year of Education
2.	Name of Institution
3.	Village/City/State
4.	Block/Tehsil
5.	District/State

10.

Information relating to Property

..............................................................................

S. No.	Immovable property/ Agricultural Land/House/Shop/Others	Area	P.H.N.	R.I.C.	Tehsil/District	Year of obtaining/ buying property
(1)	(2)	(3)	(4)	(5)	(6)	(7)
1.	On Applicant's Father's name
2.	On Applicant's Paternal Grandfather's Name
3.	On Applicant's Maternal Grandfather's Name

11.

Information relating to Caste

..............................................................................

S. No.	Relative	Caste	Sub- Caste	Clan (Gotra)	Clan Sign (Gotra Chinnha)	Line (Totem)
(1)	(2)	(3)	(4)	(5)	(6)	(7)
1.	Applicant's Father
2.	Applicant's Mother's Father
3.	If Applicant is a Lady, then her Husband

12.

Information relating to Occupation

..............................................................................

S. No.	Relative	Traditional Occupation	Present Occupation
(1)	(2)	(3)	(4)
1.	Applicant's occupation
2.	Occupation of Applicant's Father
3.	Occupation of Applicant's Paternal Grandfather
4.	Occupation of Applicant's Maternal Grandfather
5.	Occupantion of Applicant's spouse

S. No.	Detail	Father's Brother (Paternal Uncle)	Mother's Brother (Maternal Uncle)	Husband of Mother's Sister	Husband of Father's Sister	Wife's Father (Father-in-law)
(1)	(2)	(3)	(4)	(5)	(6)	(7)
1.	Name
2.	Caste
3.	Sub-Caste
4.	Clan (Gotra)
5.	Occupation
6.	Village/Town of Residence
7.	Tehsil
8.	District

30.	Attached documents :
1.	Below-mentioned documents of Applicant's father/ancestors mentioning their caste : -	:	..............................................................................
	(a) Revenue document of ancestors (case file)	:	..............................................................................
	(b) Jama-Bandi (Survey) or Girdawari B1	:	..............................................................................
	(c) State Settlement; OR	:	..............................................................................
	(d) Document of Rights (1954); OR	:	..............................................................................
	(e) Survey of Forest Department/Forest RightsCertificate; OR	:	..............................................................................
	(f) Admission Register of educationalinstitution; OR	:	..............................................................................
	(g) Register of Birth or Death; OR	:	..............................................................................
	(h) National Register of Citizens (1949); OR	:	..............................................................................
	(i) Copy of Caste Certificate, issued earlier toFather, Ancestor or a relative; OR	:	..............................................................................
	(j) Census (1931)	:	..............................................................................
2.	Such domicile certificate or any other documentverifying that ancestors of the applicant were residing in thegeographical limits of Chhattisgarh before the date 10-8-1950(Scheduled Caste), 6-9-1950 (Scheduled Tribe) or 26-12-1984(Other Backward Class).	:
3.	Family Tree commencing from ancestors to Castecertificate holder as obtained by Patwari.	:	Yes/No
4.	If applicant's father is/were an employee ofState Government and in relation to SC/ST/OBC, before dated10-8-1950, 6-9-1950, 26-12-1984 were resident of existing Stateof Madhya Pradesh and were allocated to the State of Chhattisgarhon State Re-Organization, related documents.	:	Yes/No
5.	If the applicant belongs to OBC and hisfather/mother is a government employee, document verifying theirpost and income certificate or copy of Form 16 of the precedingfinancial year.	:	Yes/No
6.	Envelope having full and legible address of :the Applicant bearing adequate postage stamps (in case thecertificate is desired through post)	:	Yes/No
7.	Affidavit of the Applicant (prescribed inFORM-2A)	:	Yes/No

I hereby solemnly/affirm that the information contained in the application is true and correct to the best of my knowledge and belief.

Place:Date:

(Applicant's Signature)

Form-2A[See Rule 3(3)(a)]Affidavit for issue of Social Status Certificate

I Mr./Mrs./Ms.................., son/daughterof.....aged......Year....................occupation..................., resident of.............Tehsil............, District............., State........ herebysolemnly affirm the following : -		Affix passportsize photograph
Signature ofapplicant

1. That I have applied for the issuance of Social Status Certificate before the Competent Authority in FORM-1A.

2. That I have, according to the prescribed form, attached the copy of............... documents along with the application letter before the Competent Authority. The document mentioned above has been obtained lawfully by the person(s) authorized by me and I have not made any unauthorized amendment/ omission/change whatsoever of any kind in the document mentioned above or its original copy by me or my well-wishers and according to the best of my knowledge, the above-mentioned document/documents have not been concocted with any malicious intention.

3. That I have attached the family tree showing relation with those relatives whose validity certificates have been attached with this application.

4. I hereby declare that, in pursuance of obtaining the Social Status Certificate, the information rendered by me in the Application presented in the prescribed form before the Competent Authority, is true to the best of my knowledge and belief and if such information is found false or incorrect, then proceedings in accordance with Section 8-13 of Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013 shall be initiated against me.

Signature................Name of the Applicant..................VerificationI, Mr/Mrs/Ms....................son/daughter........................of....................hereby verify that the statements mentioned in Clause 1 to 4 of this affidavit are true to the best of my knowledge and belief, and I verify them in full consciousness.Signature..............Name of the Applicant...............Form-2B[See Rule 15(1)]Affidavit by Person appointed, admitted, elected, named or nominated on the Reserved SeatI, Mr/Mrs/Ms....................... Son/Daughter of Mr............, Aged..............Year , Occupation.................\.... Resident of.......................... Tehsil........................,District............ State...........solemnly state the following :

(1)I have submitted an Application for the post/seat/benefit/service reserved for Scheduled Castes/Scheduled Tribes/Other Backward Classes.

(2)My appointment/admission/election/naming/nomination have been made under the reserved post/seat.

(3)I have submitted my Social Status Certificate issued by Competent Authority..............(name and post of authorized officer) certifying that I belong to Scheduled Castes/Scheduled Tribes/Other Backward Classes.

(4)The Social Status Certificate submitted by me has been issued by the prescribed officer and through prescribed process and in order to get such certificate, all information rendered by me to the Competent Authority is true to the best of my knowledge and belief.

(5)In case a complaint is received in connection with above mentioned Certificate that Certificate has been obtained fraudulently or wrongly and if on this basis or otherwise, suo moto, an inquiry is held by the District Level Certificates Verification Committee regarding my Social Status or the Social Status Certificate is referred for inquiry to the High Power Certification Scrutiny Committee and if the above committee or committees after inquiry and decision pass an order stating that Certificate has been obtained wrongly or fraudulently, my appointment/admission/election selection, profit given, facilities given, as the case may be, can be cancelled/terminated/ excluded with immediate effect by the non-applicant (name of concerned public employer/educational institution/statutory body/State Government/Central Government)................., and I shall be liable to refund the amount spent on such appointment/admission/ election/selection/profit/facilities given etc. and the above-mentioned amount may be recovered as arrears of land revenue, and I shall also be liable to action prescribed in Sections 8-13 of Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013.Signature................Name of the Applicant.................VerificationI, Mr/Mrs/Ms...................son/daughter of...................hereby verify that the statements mentioned in Clause 1 to 5 of this affidavit are true to the best of my knowledge and belief, and I verify them in full consciousness.Signature................Name of the Applicant.................Form-2C[See Rule 16 (3 & 4)]Affidavit to be filed before District Level Certificates Verification Committee

I, ................ son/daughter/wife............of..........., aged.....Year occupation , resident of.....Village........, Tehsil..........., District........................ Statehereby solemnly affirm that:		Affix passportsize photograph
Signature ofapplicant

1. I have applied for verification of my social status certificate before District Level Certificates Verification Committee in prescribed Form and in support of my claim, I hereby present this affidavit.

2. I have attached with my application, copies of the documents required under sub-rule (3) of Rule 3 in prescribed Format to verify Social Status Certificate before District Level Certificates Verification Committee. Above mentioned documents have been obtained by me legally from Competent Authority/authorities and I or any of my well-wisher have not made any correction/change/rectification and to the best of my knowledge and belief no forgery has been committed in such document/documents.

3. I have attached the family tree showing relation with those relatives whose valid caste certificates have been attached with this application.

4. I hereby declare that the information given by me in the prescribed format before social status certificate Verification Committee for verification of social status certificate is true to the best of my knowledge and I understand that in case the same is found false at any level, an action under Section 8-13 of Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013 can be initiated against me.

Place.....................Date.............................

Signature.........................

VerificationI.................son/daughter/wife of hereby verify that the statements mentioned in Clause 1 to 4 of this affidavit are true to the best of my personal knowledge and belief, and I verify them today on.........., place......... Chhattisgarh under my signature.SignatureForm-3A[See Rule 5]Office of the Competent AuthorityDivision............. District................ Chhattisgarh

Inward No................................

Dated...................................

Acknowledgment of Application [Receipts](Original copy of the memo should be given to the applicant and its counterfoil be maintained in the office)Received today...........an application to issue a Social Status Certificate from Mr/Mrs/Ms..................son/daughter/wife................of.............. aged Year....occupation...............resident of............ Tehsil................................... District..........................State..............Following documents have been received in original/attested copies thereof along with application :

(1)Following document of the Applicant or Applicant's father/ ancestors mentioning his caste :

(I)Revenue document of ancestors (case file);

(II)Jama-Bandi (Survey) or Girdawari;

(III)State Settlement;

(IV)Document of Rights (1954);

(V)Census (1931);

(VI)Survey of Forest Department;

(VII)National Register of Citizens (1949);

(VIII)Register of Birth or Death;

(IX)Admission Register, in case father or ancestors were literate;

(X)Caste Certificate, issued earlier to Father, Ancestor or a relative;

(XI)Any other document which proves the caste, as claimed by the applicant;

(XII)..........................

(2)Such document duly attested copy or copies of the documents verifying that his ancestors were residing in the geographical limits of Chhattisgarh on or before the date of Presidential Notification or date of notification in relation of Other Backward Classes, as the case may be.

(3)Family Tree given by Patwari mentioning from ancestors to Applicant.

(4)Affidavit of Applicant or his Father or his Legal Guardian in prescribed FORM-2A (in original).

(5)Documents showing that parent of the applicant are officer/employee of the State Government and on or before the date of notification of Presidential Notification and were resident of present Madhya Pradesh and on reorganization of the then State of Madhya Pradesh they have been allocated to State of Chhattisgarh.

(6)For Other Backward Classes, income certificate of father for preceding financial year or certified copy of Form 16.

(7)Envelope having appropriate postage stamp and complete and legible address.Signature and seal of recipientForm-3B[See Rule 5]Office of the Competent AuthorityMemo for Return of Application [Return Memo](Original copy of the memo should be given to the applicant and its counterfoil be maintained in the office)

Book No.....................................

Date....................................

The application to issue Social Status Certificate by Mr/Mrs/Ms..........................son/daughter of .................resident of..................lacks following documents. Hence, it is hereby directed that the following documents marked as (V) be submitted with application, so that proceeding to issue social status certificate can be initiated : -

(1)Following document of the Applicant or Applicant's father/ ancestors mentioning his caste:

(I)Revenue document of ancestors (case file);

(II)Jama-Bandi (Survey) or Girdawari;

(III)State Settlement;

(IV)Document of Rights (1954);

(V)Census (1931);

(VI)Survey of Forest Department;

(VII)National Register of Citizens (1949);

(VIII)Register of Birth or Death;

(IX)Admission Register, in case father or ancestors were literate;

(X)Caste Certificate, issued earlier to Father, Ancestor or a relative;

(XI)Any other document which proves the caste, as claimed by the applicant;

(XII)............

(2)Such document should be duly attested copy or copies of the documents verifying that his ancestors were residing in the geographical limits of State of Chhattisgarh on or before the date of Presidential Notification or Date of Notification relating to Other Backward Classes, as the case may be.

(3)Family Tree given by Patwari mentioning from ancestors to Applicant.

(4)Affidavit of Applicant or his Father or his Legal Guardian in prescribed FORM-2A (in original).

(5)Documents showing that parent of the applicant are officer/employee of the State Government and on or before the date of notification of Presidential Notification were resident of present Madhya Pradesh and after reorganization of the then State of Madhya Pradesh they have been allocated to State of Chhattisgarh.

(6)For Other Backward Classes, income certificate of father for preceding financial year or certified copy of Form 16.

(7)Envelope having appropriate postage stamp and complete and legible address.

Signature of the Applicant

Signature of the Authority

Form-3C[See Rule 6]Inability Memo(This form shall be printed on the back of FORM-2B)

To,Competent AuthoritySub-Division............................................District.....................................................		Affix passportsize photograph
Subject: Regarding inability to make available necessarydocument for issue of Social Status Certificate.		Signature ofapplicant

Sir,I................(Name of the Applicant) son/daughter of.....................Post..........Resident of.................Solemnly affirm that I have applied for Social Status Certificate on..............(Date) with Receipt No...............But I am not able to make available the required documentary evidence under sub-rule (3) of Rule 3 to substantiate my claim because :

(1)Nobody is/was literate amongst my Father or Ancestors or blood relatives of my Father;

(2)My Father or Ancestors or Blood relatives of my father did not have any immovable property and there is no document available regarding such immovable property;

(3)There is no entry regarding my father or ancestors in the public documents required under Rule 3;

(4)I do not possess any document which could be used as a proof;Hence I request you to issues Social Status Certificate after making inquiry under Rule 8 on the basis of the affidavit submitted by me. I shall submit before authority required information at the time of inquiry, I shall present myself on the date fixed by him and shall give full cooperation to seek presence of desired persons to support my claim.Signature............VerificationI Mr/Mrs/Ms....................son/daughter of hereby verify that the statements mentioned above in this affidavit are true to the best of my knowledge and belief, and I verify them in full consciousness.Signature.........Name of the Applicant........Form-3D[See Rule 16(2)]Office of the District Level Certificates Verification CommitteeDistrict............, Chhattisgarh

Inward No. ...........................

Dated ............................

Acknowledgment of Application [Receipt](Original copy of the memo should be given to the applicant and its counterfoil be maintained in the office)Received today an application for verification of Social Status Certificate from Mr/Mrs/Ms...............son/daughter/wife of............. aged....... Year........., occupation...........resident of.......... Tehsil......... District................State..........Following documents have been received in original/attested copies thereof along with application:

(1)Following document of the Applicant or Applicant's father/ ancestors mentioning his caste:

(I)Revenue document of ancestors (case file);

(II)Jama-Bandi (Survey) or Girdawari;

(III)State Settlement;

(IV)Document of Rights (1954);

(V)Census (1931);

(VI)Survey of Forest Department;

(VII)National Register of Citizens (1949);

(VIII)Register of Birth or Death;

(IX)Admission Register, in case father or ancestors were literate;

(X)Caste Certificate, issued earlier to Father, Ancestor or a relative;

(XI)Any other document which proves the caste, as claimed by the applicant;

(XII).................

(2)Such document or duly attested copy or copies of the documents verifying that his ancestors were residing in the geographical limits of Chhattisgarh on or before the date or Presidential Notification or date of notification relating to Other Backward Classes, as the case may be;

(3)Family Tree given by Patwari mentioning from ancestors to Caste Certificate holder/Social Status Certificate holder;

(4)Affidavit of Applicant or his Father or his Legal Guardian in prescribed FORM 2-A (in original);

(5)Documents relating to parent of the applicant showing that they are officer/ employee of the State Government and on or before the date of Notification of Presidential Notification were resident of present Madhya Pradesh and on reorganization they have been allocated to State of Chhattisgarh;

(6)For Other Backward Classes, income certificate of father for preceding financial year or certified copy of Form 16;

(7)Envelope having appropriate postage stamp and complete and legible address.Signature and seal of recipient.Form-4A(1)[See Rule 9]Office of Competent AuthorityDivision...........District..............Chhattisgarh

Book No. ........................Serail No. ...........................

Dated ............................

Social Status Certificate(For Scheduled Castes)(On sky-blue paper)It is hereby certified that Mr/Mrs/Ms.......................son/daughter of...................resident of village..........Tehsil..........District belongs to.......caste and according to Article 341, such caste is included in connection with the State of Chhattisgarh as Scheduled Caste and such caste is mentioned on the serial number................... of Schedule 3, under Section 19 of Madhya Pradesh Reorganization Act, 2000. Therefore, Mr/Mrs/Ms...................son/daughter of.............belongs to Scheduled Caste.

2. This certificate has been issued under the provisions that in case the District Level Certificates Verification Committee or High Power Certification Scrutiny Committee during its inquiry/inspection finds the claim submitted by Mr/Mrs/Ms............................... is false or fraudulent, the certificate shall be deemed to be cancelled with immediate effect and notwithstanding anything contained under any other law for the time being in force, action shall be initiated under Section 8-13 of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013.

SignatureName of Certifying OfficerDesignation/SealForm-4A(2)[See Rule 9]Office of Competent AuthorityDivision...........District..............Chhattisgarh

Book No. ........................Serail No. ...........................

Dated ............................

Social Status Certificate(For Scheduled Tribes)(On light-pink paper)It is hereby certified that Mr/Mrs/Ms...................son/daughter of........................resident of village..........Tehsil..........District ..........., belongs to............tribe and according to Article 342, such tribe is included in connection with the State of Chhattisgarh as Scheduled Tribe and such tribe is mentioned on the serial number................... of Schedule 3, under Section 20 of Madhya Pradesh Reorganization Act, 2000. Therefore, Mr/Mrs/Ms ..................son/daughter of belongs to Scheduled Tribe.

2. This certificate has been issued under the provisions that in case the District Level Certificates Verification Committee or High Power Certification Scrutiny Committee during its inquiry/inspection finds the claim submitted by Mr/Mrs/Ms......................................is false or fraudulent, the certificate shall be deemed to be cancelled with immediate effect and notwithstanding anything contained under any other law for the time being in force, action shall be initiated under Section 8-13 of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013.

Signature Name of Certifying Officer Designation/SealForm-4A(3)[See Rule 9]Office of Competent AuthorityDivision..........District..............Chhattisgarh

Book No. ........................Serail No. ...........................

Dated ............................

Social Status Certificate(For Other Backward Classes)(On light-yellow paper)It is hereby certified that Mr/Mrs/Ms.....................son/daughter of......... resident of village........Tehsil.........District , belongs to.has been recognized as Other Backward Classes vide Notification no. F-8-5/25/4/84 dated 26th December 1984, as amended from time to time by subsequent notifications, and this caste is mentioned at serial no..............as Other Backward Class of Chhattisgarh State. Therefore, Mr/Mrs/Ms............... son/daughter of............belongs to Other Backward Class.

2. This is also certified that Mr/Mrs/Ms...........does not belong to the category of creamy layer persons/classes which have been mentioned in the circular no. 36012/22/93/ESTT (SCT) dated 8-9-1993 as amended by notification no. 36033/3/2004-ESTT (Reservation) dated 14-10-2008 of Government of India, Department of Personal and Training and in column 3 of circular number F-9-3/2001/1-3, dated 24-6-2009 of General Administration Department.

3. This certificate has been issued under the provisions that in case the District Level Certificates Verification Committee or High Power Certification Scrutiny Committee during its inquiry/inspection finds the claim submitted by Mr/Mrs/Ms................... is false or fraudulent, the certificate shall be deemed to be cancelled with immediate effect and notwithstanding anything contained under any other law for the time being in force, action shall be initiated shall be initiated under Section 8-13 of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes, (Regulation of Social Status Certification) Act, 2013.

SignatureName of Certifying OfficerDesignation/SealForm-4B[See Rule 10]Office of Competent Authority

Book No. ........................Serail No. ...........................

Dated ............................

Provisional Social Status Certificate(On white paper)(Valid only for the purpose of granting admission and scholarship/stipend or any such other purposes in educational institutions of primary/secondary level)It is hereby certified that on the basis of affidavit submitted by Mr/Mrs/Ms..........son/daughter of............resident of village............Tehsil........................District.................he/she belongs to caste/tribe/OBC (not included in creamy layer of OBC) and according to Article 341/342/Notification of the State Government, such caste is included in connection with the State of Chhattisgarh as Scheduled Caste/Scheduled Tribe/OBC and such caste/tribe is mentioned on the serial number................of Schedule 3, under Section 19 of Madhya Pradesh Reorganization Act, 2000/Schedule 4, under Section 20 of Madhya Pradesh Reorganization Act, 2000/State List of OBC and Mr/Mrs./Ms .........son/daughter of.......belongs to Scheduled Caste/Scheduled Tribe/OBC.

2. It is certified that annual family income of Mr/Mrs/Ms.................................................is Rs..............

3. This certificate has only been issued for the immediate purpose of getting scholarship/stipend provided by Government of India/State Government and the certificate is valid only for six months from the date of issue or till the issue of permanent social status certificate, whichever is earlier.

Designation/Seal

SignatureName of CertifyingOfficer

Form-4C[See Rule 11]Office of Competent AuthorityDivision............District...........Chhattisgarh

Book No. ........................Serail No. ...........................

Dated ............................

Social Caste Certificate (Migrant)This is to Certify that Shri/Shrimati/Kumari Son/Daughter of........of Village/Town..................in...............District/Division of the State/Union Territory.................belongs to the............Caste/Tribe which is recognized as a Scheduled Caste/Scheduled Tribe under : -

1. The Constitution (Scheduled Caste) Order, 1950

2. The Constitution (Scheduled Tribes) Order, 1950

3. The Constitution (Scheduled Castes) (Union Territories) Order, 1950

4. The Constitution (Scheduled Castes) (Union Territories) Order, 1951 As amended by the Scheduled Castes and Scheduled Tribes Lists (Modification) Order, 1956 the Bombay Reorganisation Act, 1960 the Punjab Reorganisation Act, 1966, the State of Himachal Pradesh Act, 1970, the North Eastern Areas (Reorganisation) Act, 1971 and the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976.

5. The Constitution (Jammu and Kashmir) Scheduled Castes Order, 1956.

6. The Constitution (Andman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended by Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976.

7. The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order, 1962.

8. The Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order, 1962.

9. The Constitution (Pondichery) Scheduled Castes Order, 1964.

10. The Constitution Scheduled Tribes (Uttar Pradesh) Order, 1967.

11. The Constitution (Goa, Daman And Diu) Scheduled Castes Order, 1968.

12. The Constitution (Nagaland) Scheduled Tribes Order, 1970.

13. The Constitution (Sikkim) Scheduled Castes Order, 1978.

14. The Constitution (Sikkim) Scheduled Tribes Order, 1978.

*This Certificate is issued on the basis Of the Scheduled Castes/Scheduled Tribes Certificate issued to Shri/Shrimati/Kumari Son/Daughter of.................................................of Village/Town..................in...............District/Division..................... of the State/Union Territory.....................who belong to the.....Caste/Tribe which is recognized as a Scheduled Castes/Scheduled Tribe in the State/Union Territory..................issued by the.................(name of prescribed authority) vide their no.............dated............and the holder on the certificate is not entitled to any concession/facilities extended to Scheduled Castes/Scheduled Tribes by the Government of Chhattisgarh.**Shri/Shrimati/Kumari................and or his/her family ordinary resides(s) at village/town..........of........District/Division of the State of Chhattisgarh.Signature Designation (With Seal of Officer)*Applicable to Migrants only**Not applicable to Migrants.Form-4D(1)[See Rule 17(1)]

Serail No. ...........................

Dated ............................

Verification Certificate(For Scheduled Castes)(On sky-blue paper)Mr/Mrs/Ms................son/daughter of................resident of village............................Tehsil District Chhattisgarh has been issued a Social Status Certificate serial no................dated............by Competent Authority...............In the light of document...............(details of the document) as required under Rule 3(3) of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013 and after the inquiry and satisfaction to this committee is verified.

2. Mr/Mrs/Ms...........................son/daughter...........................of...................resident of village............. Tehsil................................. District...................... Chhattisgarh is of.....caste/tribe is a Scheduled Caste of State of Chhattisgarh under Article 341 of the Constitution, which is mentioned on the serial number of Third Schedule of Section 19 of the Madhya Pradesh Reorganization Act, 2000.

Investigation Officer	Inquiry Officer/Member	Chairman
District Level	District Level	District Level
Certificates	Certificates	Certificates
Verification Committee	Verification Committee	Verification Committee
District................	District.............	District............
Chhattisgarh	Chhattisgarh	Chhattisgarh

Form-4D(2)[See Rule 17(1)]

Serail No. ...........................

Dated ............................

Verification Certificate(For Scheduled Tribes)(On light-pink paper)Mr/Mrs/Ms................son/daughter of resident of village........Tehsil District , Chhattisgarh has been issued a Social Status Certificate serial no................dated............by Competent Authority In the light of document................(details of the document) as required under Rule 3(3) of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013 and after the inquiry and satisfaction to this committee is verified.

2. Mr/Mrs/Ms..........................son/daughter of.......................resident of village............Tehsil.............District...........Chhattisgarh is of.....caste/tribe is a Scheduled Tribe of State of Chhattisgarh under Article 342 of the Constitution, which is mentioned on the serial number...............of Fourth Schedule of Section 20 of the Madhya Pradesh Reorganization Act, 2000.

Investigation Officer	Inquiry Officer/Member	Chairman
District Level	District Level	District Level
Certificates	Certificates	Certificates
Verification Committee	Verification Committee	Verification Committee
District................	District.............	District............
Chhattisgarh	Chhattisgarh	Chhattisgarh

Form-4D(3)[See Rule 17(1)]

Serail No. ...........................

Dated ............................

Verification Certificate(For Other Backward Classes)(On light-yellow paper)Mr/Mrs/Ms................................son/daughter of................resident of village................. Tehsil............District.............. Chhattisgarh has been issued a Social Status Certificate serial no..............dated by Competent Authority...............In the light of document............(details of the document) as required under Rule 3(3) of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013 and after the inquiry and satisfaction to this committee is verified.

2. Mr/Mrs/Ms.................son/daughter of............resident of village..........Tehsil..........Chhattisgarh is of.........caste/tribe is member of Other Backward Classes of the State of Chhattisgarh as per Notification no. F-8-5/25/4/84 dated 26th December 1984, as amended from time to time, and this caste is mentioned on serial no..........as Other Backward Class of Chhattisgarh State.

3. This is to certify that total annual family income of Mr/Mrs/Ms............is Rs..........

Investigation Officer	Inquiry Officer/Member	Chairman
District Level	District Level	District Level
Certificates	Certificates	Certificates
Verification Committee	Verification Committee	Verification Committee
District................	District.............	District............
Chhattisgarh	Chhattisgarh	Chhattisgarh

Form-5A[See Rule 4]Format for Registration of Application received at the Office of the Competent Authority

Sl.	Case No.	Date of receipt of Application	Name of Applicant
1	2	3	4

Father's Name	Current Address	Caste which Claimed	Date of issue of Certificate
5	6	7	8

Form-5B[See Rule 10]Format for Registration and Forwarding of Application for Provisional Social Status Certificate received at the Office of the Competent Authority

SI.	Case No.	Date of receipt of Application	Name of Applicant	Father's Name
1	2	3	4	5

Current Address	Caste which Claimed	Date of issue of Provisional Certificate	Date of forwarding to Competent Authority forPermanent Certificate
6	7	8	9

Form-5C[See Rule 13]Format for Registration of Social Status Certificate Documents

SI.	Case No., book No., and Serial No. of Certificate	Date of issue of Certificate	Name of Applicant	Father's Name
1	2	3	4	5

Current Address	Certificate of which Caste Issued	Details of Documents enclosed	Name of Issuing Authority
6	7	8	9

Form-5D[See Rule 16]Format for Registration of Application received for Verification of Social Status Certificate

Sl.	Case No.	Date of receipt of Application	Name and detail of Non Applicant
1	2	3	4

Name of Applicant	Father's Name	Current Address	Date of issue of Certificate	Remarks
5	6	7	8	9

Form-5E[See Rule 17(2)]Format for Registration of Documents for Verification Certificate

Sl.	Case No., Book No. and Serial No. of Certificate	Date of issue of Certificate	Name and Applicant
1	2	3	4

Father's Name	Current Address	Certificate of which Caste Issued	Details of Documents enclosed	Remarks
5	6	7	8	9

Form-5F[See Rule 18(2)]Format for Registration of Detail of Application forwarded by the District Level Certificates Verification Committee to the Scrutiny Committee

SI.	Case No.	Name of Applicant/Father's Name of whose SocialStatus Certificate has been forwarded to the Scrutiny Committeefor Investigation and Scrutiny
1	2	3

Name and Address of Competent Authority issuingthe said Certificate	No. and Date of the Forwarded Social StatusCertificate	Order No. and Date of Scrutiny Committee	Remarks
4	5	6	7

Form-5G[See Rule 19]Format for Registration of Cases by Scrutiny Committee

Sl.	Case No.	Date of receipt of Application	Name of Applicant
1	2	3	4

Father's Name	Current Address	Date of receipt of Verification Certificate	Remarks
5	6	7	8

Form-5H[See Rule 20(7)]Details of investigation of Cases received from the Scrutiny Committee by the Police Inspectors (Vigilance Cell)(Separate Pages of Register be used for Each Case)

Sl.	Case No/Name of Applicant/ Father's Name/Presentaddress whose certificate is to be Investigated	Name/Father's Name/ Current Address ofComplainant, if any	Date of receipt of Case
1	2	3	4

Name of Police Inspector/s who has been assignedInvestigation	Date of assigning Case for investigation	Detail of Dates and Places visited by Policeinspectors for investigation	Name, Father's Name, Post held and other detailsof those persons interrogated/ Statements/Affidavit obtained, byPolice Inspectors during investigation and date of such action
5	6	7	8

Name, Father's Name and other details ofApplicant, his father/mother, relatives and other informedpersons interrogated/Statements/Affidavit obtained, by PoliceInspector/s, during investigation and date of such action	Details of Public and Private Documents examinedby Police Inspector/s, during investigation	Details of Public Documents Ceased by PoliceInspector/s, during investigation
9	10	11

Details of Documents submitted to Forensic andHandwriting expert by Dy. Spdtt. of Police and date of submission	Date of receipt of Forensic and Handwritingreport	Date of submission of Investigation report bythe Police Inspector/s to the Dy. Spdtt. of Police	Date of Submission of Investigation Report by theDy. Spdtt. of Police to the Committee
12	13	14	15

Form-5I[See Rule 23(5)]Format for Registration of Details of Certificates Confiscated by the Scrutiny Committee

Sl.	Case No.	Name/Father's Name of Applicant/Address ofApplicant whose Social Status Certificate has been confiscatedand ceased
1	2	3

Name and Address of Competent Authority issuingthe Social Status Certificate	No. and Date of the confiscated and ceased SocialStatus Certificate	Order No. and Date of Scrutiny Committee	Remarks
4	5	6	7

Form-6A[See Rule 20(1)]Office of High Power Certification Scrutiny Committee

SI.No. ...........................

Dated ............................

To,The Deputy Supdtt. of PoliceVigilance Cell(Investigation and Scrutiny of Social Status)RaipurSub. : Investigation and Scrutiny of Social Status of Shri/Smt./Ku.........................S/o, D/o, W/o, resident of reg.Ref. : Letter No........................Dated of District Level Certificates Verification Committee /Govt, of Chhattisgarh (Name of Administrative Department).Kindly find enclosed herewith Case No................................................... of Shri/Smt./Ku................................................................ S/o/D/o/W/o.resident of................submitted for investigation and scrutiny by District Level Certificates Verification Committee, District.............................. Chhattisgarh/Govt. of Chhattisgarh..................(Name of Administrative Department) vide their letter No. ..............Dated............As directed, you are requested to ensure that the case is investigated under provisions of Rule 20 of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013, by you in person or by Police Inspector/s under you, and the report, containing clear opinion, along with originals of all documents, statements and affidavits of witnesses, is to be submitted to the Committee at the earliest.

2. You are also directed to ensure that details of the above investigation are maintained in the register of the Cell as per FORM-5H of the Rule and a copy of the same is to be furnished to this Committee.

Encl.:As above	Member Secretary or Vice ChairmanHigh Power Certification ScrutinyCommittee
Copy Endorsed to :	Date...........................

1. Secretary /Principal Secretary, Govt, of Chhattisgarh, Scheduled Tribe and Scheduled Caste Development Department, Mantralaya, Mahanadi Bhavan, New Raipur.

2. Chairman, District Level Certificates Verification Committee, District .................... Chhattisgarh/Secretary/Principal Secretary/Addl. Chief Secretary, Govt, of Chhattisgarh, ........................ Department (Name of Administrative Department), Mahanadi Bhavan, New Raipur.

Member Secretary or Vice ChairmanHigh Power Certification ScrutinyCommitteeForm-6B[See Rule 20(1)]Office of High Power Certification Scrutiny CommitteeSl. No............................................#Dated...........To,Shri/Smt./Ku......................S/o,/D/o, W/o ....................Resident of.......................Show Cause NoticeInvestigation of your Social Certificate, submitted for investigation and scrutiny to this Committee by District Level Certificates Verification Committee, District............ Chhattisgarh/Govt. of Chhattisgarh...................(Name of Administrative Department) vide their letter No............Dated.........., has been conducted by Dy. Supdtt. of Police, Vigilance Cell (Investigation and Scrutiny of Social Status). As per the report of Dy. Supdtt. of Police, your Social Status Certificate is false and fraudulently obtained.

2. Therefore, in exercise of powers conferred by Section 15 of Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013, and as prescribed in Rule 22 of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013, this Committee has made the penultimate decision to investigate your claimed Social Status Certificate on the basis of investigation report submitted by the Dy. Supdtt. of Police of Vigilance Cell (Social Status Investigation and Scrutiny Committee), Raipur.

3. The investigation report and the copy of statement of relevant witnesses and other documents submitted by the Dy. Supdtt. of Police of Vigilance Cell (Social Status Investigation and Scrutiny Committee), Raipur are enclosed herewith. You are directed to submit your clarification in this regard within 15 days from the date of receipt of this letter and say :

1. Whether you desire a Personal Hearing.

2. Whether you desire an Oral Enquiry.

3. If you desire to produce any witness and documents in support of your Social Status, if yes, submit list.

4. You are also informed that if your clarification in this regard is not received by this Committee within the above mentioned period, it shall be assumed that you have nothing to say in this regard and one-sided action shall be taken against you.

Encl.:As above

Member Secretary or Vice ChairmanHigh Power Certification ScrutinyCommittee

Form-6C[See Rule 22(5)]Office of High Power Certification Scrutiny CommitteeSI. No....................................Dated...........To,Tehsildar/Addl. Tehsildar/Nayab Tehsildar............................................Sub.: Public notice above Investigation and Scrutiny of Social Status of Shri/Smt./Ku. S/o,/D/o,/W/o, ........., resident of...............by beating of Drum-reg.The investigation and scrutiny of the Social Status Claim of Shri/Smt./Ku ...................... S/o,/D/o,/W/o, , resident of....is being done by this Committee, in exercise of powers conferred by Section 15 of Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Act, 2013, and as prescribed in Rule 22 of the Chhattisgarh Scheduled Castes, Scheduled Tribes and Other Backward Classes (Regulation of Social Status Certification) Rules, 2013.

2. If any person or institution from the present, erstwhile or permanent residence of Shri/Smt./Ku................... S/o,/D/o,/W/o,............................ resident of...........,wishes to support or oppose the Social Status Claim of the applicant, it may do so.

3. Therefore, a public notice may be circulated by way of pasting written notice or by beating drum in the context of the above enquiry of Shri/ Smt./Ku.............................S/o,/D/o,/W/o resident of., in...............(name of Village/Mohalla/Area) that if any resident or institution or any other person of the area who has knowledge of the Social Status of Shri/Smt./Ku..............S/o,/D/o,W/o, resident of., may appear before the Committee on.................(Date)...............(Hour)............(Place) and may produce oral statement or affidavit or any relevant document.

Member Secretary or Vice ChairmanHigh Power Certification Scrutiny CommitteeForm-7A[See Rule 27(2)]Progress report regarding issuance of Social Status Certificate or rejection of application

Name of District...........................

Year 20............................

Sl.	Name of Sub-Division	Month	No. of Applications received during the Month	No. of pending Applications for the previousMonths
1	2	3	4	5

No. of Total Applications (3 + 4)	No. of Certificates issued during the month	No. of rejected Applications	No. of Certificates forwarded to DistrictVerification Committee	No. of Applications pending at the end of themonth
6	7	8	9	10

Form-7B[See Rule 27(3)]Progress report regarding issuance of Social Status Certificate, rejection of application to the Scrutiny Committee

Name of District...........................

Year 20............................

Sl.	Month	No. of Application/ Certificates received fromSub-Division Officers	No. of Application/ Complaints received fromnon-applicants	No. of pending Applications for the previousMonths
1	2	3	4	5

No. of Total Applications (3 + 4)	No. of Certificates verified during the month	No. of rejected Applications	No. of Certificates forwarded to ScrutinyCommittee	No. of Applications pending at the end of themonth
6	7	8	9	10

Form-7C[See Rule 27(4)]Progress report regarding disposal of Social Status Certificate and Complaints received regarding them

Name of District...........................

Year 20............................

Sl.	Month	No. of Cases received from State Governmentduring the month	No. of Cases Received from VerificationCommittees	No. of pending Cases for the previous Months
1	2	3	4	5

No. of Total Cases (3 + 4)	No. of Cases disposed during the month	No. of rejected Certificates	No. of Cases pending at the end of the month	Remarks
6	7	8	9	10

13.	Applicant's Mother tongue	:	..............................................................................
14.	If Applicant's caste has a separate dialect,then name of the dialect	:	..............................................................................
15.	If Applicant's Caste has a God/ Goddess thenname of the God/ Goddess	:	..............................................................................
16.	Name of important Gods/ Goddesses of Applicant'scaste	:	..............................................................................
17.	Name of Folk Dances of Applicant's Caste	:	..............................................................................
18.	Name of Folk Songs of Applicant's Caste	:	..............................................................................
19.	Name of important festivals of Applicant's Caste	:	..............................................................................
20.	Whether matrimonial relation with son/daughterof father's sister is permitted in Applicant's Caste ?	:	..............................................................................
21.	Whether matrimonial relation with son/daughterof mother's brother is permitted in Applicant's Caste ?	:	..............................................................................
22.	Whether custom of Bride-Pricing is prevalent inApplicant's Caste ?	:	..............................................................................
23.	Whether custom of dowry is prevalent inApplicant's Caste ?	:	..............................................................................
24.	Name of those Castes/Clans with whom marriagesof Applicant's Caste/Clan are possible	:	..............................................................................
25.	Name of those Castes with whom Applicant's Castehas the relation of Roti (Bread)	:	..............................................................................
26.	Name of Castes those are equivalent toApplicant's Caste	:	..............................................................................
27.	Applicant's Religion	:	..............................................................................
28.	Religion of Applicant's father	:	..............................................................................
29.	Details of Applicant's Relatives	:	..............................................................................

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