Welcome to Backward Classes Welfare Department

Government of West Bengal

Backward Classes Welfare Department

Application form for SC/ST/OBC Certificate

1. Application to:

State : *

West Bengal

District *

Sub-Division *

Municipality

Block

GP/ward *

2. Application For:

OBC

Caste/Tribe/Community: *

3. Name: *

4. Father's Name: *

5. Mobile:

6. Email:

7. Documents Required(Atleast One) *

A. Epic No.:

B. Aadhaar No.:

C.(I) Select Category:

C.(II) Khadyasathi No.:

8.(A) Date of Birth *

(B) Place of Birth *

District *

Police Station *

Village/Town *

9. Address:

a) Present Address for Last 6 Months:

C/O (Name):

State: *

District: *

Police Station: *

Ward/GP: *

Vill/Para/House No./Road: *

Post Office: *

Pin Code:

b) Permanent Address:

Same as Present?

Yes

C/O (Name):

State: *

District: *

Police Station: *

Ward/GP: *

Vill/Para/House No./Road: *

Post Office:

Pin Code:

Any more?

Yes

10. Nationality : * INDIAN

11. Religion:*

12. Gender: *

13. Blood relation details:

Yes

a) Certificate holder's name: *

b) Certificate No: *

c) Date of issue: *

d) Relation with applicant: *

e) Issuing authority: *

14. Details of two(2) local referees:

a) Name of Referee-I: *

b) Address of Referee-I: *

c) Name of Referee-II: *

d) Address of Referee-II: *

15. Whether the applicant or his family migrated from other State/Country?

Yes

Migration Certificate No:

Date of Issue

Country:

State:

District:

Police Station:

Village/Ward:

Year of migration: