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Compilation Vol 3 Corrected (1-943).pmd - Goa Public Service ...

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To<br />

The Tahsildar<br />

......... Taluk<br />

......... District.<br />

Sir,<br />

“FORM C”<br />

[See Rule 3-A(1)]<br />

Application for Income and Caste Certificate<br />

I, ..................... son/daughter/wife/husband of Sr/Smt.......................... do hereby submit the<br />

following information for issue of Caste Certificate for claiming the reservation.<br />

1. Candidate’s Name and Occupation ..<br />

4. Name and occupation of father/mother/<br />

Guardian/wife/husband (whether occupation<br />

is Govt./Semi-Govt./<strong>Public</strong> Sector/Private one) ...<br />

7. Candidate’s caste/sub-caste and Category<br />

(Documents produced) ..<br />

9. Annual income of the candidate, candidate’s<br />

Father/mother/guardian (if father/mother is not alive)<br />

(If in Government/Semi-Government/<strong>Public</strong><br />

Sector/Private)<br />

i. Pay scale<br />

ii. Particulars of Land<br />

iii. Other sources<br />

Karnataka PSC<br />

10. Whether the candidates/father/mother/wife/husband<br />

is eligible after applying by creamy layer principle.”<br />

16. Proceeding further, Forms D, E and F are the forms of Certificates to be issued under Rule 3-<br />

A(2)(3). Form D is exclusive to Schedule Caste or Scheduled Tribe candidates. Form E is ‘Certificate<br />

to be issued to a candidate belonging to backward classes’, and reads as follows:<br />

501

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