AFFIDAVIT FOR CASTE CERTIFICATE
I, {{full_name}}, S/o / D/o / W/o {{father_s_mother_s_husband_s_full_name}}, aged {{age}} years, R/o (Complete Residential Address), do hereby solemnly affirm and declare as under:
1. That I belong to {{caste_community_name}} {{caste_community_name}}, which falls under the {{sc_st_obc_ews_category}} {{sc_st_obc_ews}} category, as per the list notified by the {{central_state_government}} {{central_state}} Government vide notification No. {{notification_number}} dated {{date_of_notification}}.
2. That I am a permanent resident of {{village_town_name}} {{village_town}}, Tehsil {{tehsil_name}}, District {{district_name}}, State {{state_name}}, and my family has been residing at the said place/State since {{date_year_or_since_birth_generations}}.
3. That my father, {{father_s_full_name}}, and forefathers originally belonged to the said caste/community and were permanent residents of {{original_village_town_district_state}}.
4. That a Caste Certificate bearing No. {{caste_certificate_number}} dated {{date_of_issue}} was earlier issued to {{self_father_family_member}} by {{name_of_issuing_authority}} {{issuing_authority}}, a copy of which is annexed herewith.
5. That I have not converted to any other religion, and my caste status as {{caste_community_name}} continues to remain valid and unchanged as on the date of this affidavit.
6. That I require this affidavit for the purpose of {{select_applicable}}: □ obtaining a fresh Caste Certificate □ renewal □ admission □ employment □ government scheme benefit, and I undertake to use the certificate strictly for lawful purposes.
7. That in case any information furnished herein is found to be false at any stage, I shall be liable for cancellation of the certificate/benefit availed and further liable for penal action under law, including under the SC/ST (Prevention of Atrocities) Act and other applicable provisions for false caste claims.
8. That the contents of this affidavit are true and correct to the best of my knowledge and belief, and nothing material has been concealed therefrom.
VERIFICATION
Verified at {{place_of_verification}} on this {{day}} day of {{month}}, {{year}}, that the contents above are true and correct to the best of my knowledge and belief.
DEPONEN
{{signature}}
Name: {{full_name}}
Caste/Category: {{caste_category_name}}