After giving opportunity of hearing, The Member Secretary of the Concerned Scrutiny Colmlittee shall hle a complaint with the previous sanction of the State Government against tlie officer concemed who has deliberately or intentionally issued a false Scheduled Tribe cefiificate in a criminal court having jurisdiction to try the offence.
15. Procedure for issuance ofduplicate copy of Validity Certificate'- If the original Validity Certificate is lost or stolen or destroyed by natural calamities like fire, flood, ealthquake etc; a duplicate laminated Validity Certificate shall be issued by the Scheduled Tribe Certificate Scrutiny Committee after verification of original record. The application for issuance of duplicate copy of Validity Certificate shall be made along witl'r an affidavit duly sworn. Such certificate shall be clearly marked as "Duplicate".
16. Preservation of record by Competent Authority and by the Scheduled Tribe Certifi cate Scrutiny Committee.
(1) The Competent Authority shall preserve the record of the Scheduled Tribe Certificate in the following manner:-
(i) Consolidated register of issuance of Scheduled Tribe Certificate : - Permanent Record.
(ii) Individual case :- Thirty Years.
(iii) Any other record :- Ten years
(2) Tlie Scrutiny Committee shall preserve the record in the following manner:-
(i) Case Register:- Permanent record.
(ii) lndividual cas record:- Permanent record.
(iii) Any other record:-Ten Years.
331-8 GUJARAT GOVERNMENT GAZETTE, EX. 19-09-2020 [ PART-IV-B
(b) The scrutiny committee shall communicate within one month from the date of decision of the inquiry to the paren guardian and the applicant
PART-rV_B l GUJARAT GOVERNMENT GAZETTE, EX. lg.Og-2020 FORM-A [see rule 3(t)) Application Form for oLtaining Scheduled Tribe Certificate The Competent Authority, subject: Apptication for obtaining a Schedured rribe certificate.
I, the undersigned..........
request for ghter and in support of my claim, I am Certificate for myself, my son/ dau information and documents, namely:_ t. (a) Full name ofthe applicant:
(b) present address :
(c) Taluka and District :
(d) Name of the post office :
Photograph of the . Applicant a Scheduled Tribe submitting following 2' Full Name of father and fu, address (if not alive, address ofhis rast residence)
3. (i) Naine of the Scheduled Tribe :
(ii) Sub tribe :
4. Information of the person for whom the certificate is required_
(a) original village (place)/ Taluka/D. isrrict of the applicant,s father / grand-father /great grad-father.(where the applicanr's family was residing ; Ei]ilffi;
I 950 or on the date of notification of that particular tribe) :
(b) Name of the village, if a person is residing in the village other than his originalvillage (ordinary place ofresidence) :.
(c) Place of Birth :
(d) Name of Primary School, Village, Taluka, District where he/ she studied :
(e) Name of Secondary Schoot/ collage - V lage, Taluka, Distnct where he/ shestudied :
5. Evidence in support of the Scheduled Tribe claim:-
(a) (i) Extract of the birth register in respect of appricanr, his father / grand-father. / great grand-father or any other elderly relatives from patemal side :
(ii) Extract of the primary schoor Admission Register of the Applicant, his father or grandfather / great grand-father, if available
(iii) Primary school Leaving certificate ofthe applicant and his father / grandfather / great grand-father :
(b) Fanrily Tree affiflred by Talati (starting fi.om grear grand_father);
To, 33 r-9 331-10 GUJARAT GOVERNMENT GAZET'TE, EX' 19-09-2020 [ PART-TV'B
(c) Lightbill / extract from Aakaranee register / Tax receipt of residence etc;
(d) Validity Certificate, if any of the father or real uncle or any otlrer elderly relative from '-' p.r"*ul side ofthe applicarrt granted by the Scrutiny Committee:
or
(e) An extract of service record (book) mentiolring tribe.of th-e applicant's father or blood relatives who "r" in cou"rnl"nt or any othei service, if any mentioning Scheduled Tribe.
or
(f) Revenue record or village panchayat record'
(g) Affidavit in Form A- l ' Iherebydeclarellrattlreinformationfurnishedbymeinapnlicationiscorrectandlamaware that on, it is found to u" rr.".."i]i*i[ i" p.**:r,.a.,ura"iti,e provisions of sections 199' 200 -J iS3 "r,h" Irdian Penal Code and shall be punished accordingly' Yours faithfullY, (Signature of the APPlicant) Place Date
PART-IV-B ] GUJARAT GOVERNMENI' GAZETTE, EX. I9-09-2OZO FORM A.r fsee rule j(2)] Photograph ofthe Applicant l. An aflidavit to be submitted to the Competent Authority with the Applicatiotr form to obtain a Scheduled Tribe Certificate by the Applicant i3l-l I I, Shlil Smt.........................
Son/ daughter ofShri............ presently residing at (Address) or My forefathers have been living in this State since 1950/ have migrated to this State before 1950, the permanent address is belongs to...... ..... .. the state of tribe which is recognized as Scheduled Tribe in the State ofGujarat;
I hereby declares on oath that the information given above in respect of myself is fully conect and.I take full responsibility of the accuracy of this statement. If at any point of time a part of the statement is found to be incorrect, I shall have to forfeit the benefit received and shall also be liable to be punished under section 193 ofthe Indian penal code.
PIace Date:...
(Signature of the Applicant) ......., have applied for Scheduled Tribe Certificate for myself, and hereby declare that:- l. I am a citizen oflndia;
2. I am a permanent resident of the state of Gujarat, my permanent address is
3. Earlier I had not applied for this Scheduled Tribe or such certificate was not issued to me or refused by the Authority of the state of Gujarat or any other state.
4. I am a resident of the address declared above;
5. I..............
331-12 village.
District that Shri/ ...........in Photogra ph of the Applicant This is to certify Shrirnati/ Kumari... ..... . '...... Son/daughter of' GUJARAT GOVERNT!{ENT GAZETTE, EX' 19-09-2020 FORMB lsee rule 4 (j)) Government of Gujarat Form of Scheduled Tribe Certificate IPART-TV-B certificate Number:
Place:
Date:
of of ... Tribe, Sr S ignature of the competent Authority' (Name.,.... ... ... ..... . ') Designation.......
(With Seal of Office) Tehsil of No.........
of the State of Gujarat belongs to Which is iecognized as a Scheduled Tribe:- Under: The Constilution (Schcduled Castcs) Ordcr' l95O: Thc Constitution (Schcdulcd Tribes) Ordcr' 1950;
The constirurion(schcdutcd casres) ( u;'#i;iffi;i il;,.9;i, The consritution(schedulcd rribes) (union Tcrritories) if::J::i., by thc schcdured casre and schedurcd rribcs Lists;; {Modification) order, r956, Thc Bombav Rcorganisation Acr 1960, The punjab n"organ,z.t,ol'1'ci"l *i, ff'" Statc iiimachal Pradish Act, 1970, Thc Noith Eastcrn Arcas lReoreanisations Act. t97l ) and tfie ScfturcJ Casi"s ana S*caulcd Tribcs ordcrs(Amendment) Act 1976' ftr"-C'*t,itrti- t"-.u ,q.nd Kashmir Schedulcd Casrc ordcr'1955 .- il; a;;ii;;;;aA;Janran end Nikobar lsland)Scheduled csstc orde'.' 1962' il; a;;;;ii;;;;iD"dra And Nasar Havcli) scheduled castc ordcr' 1962' Trre constiturion iDadra And Nsgu Havcli) Scheduled Tribcs order' Iv6z' The Constitution (Pondichcryy) Scheduled Caste Order' 1964' ri" ionstitrtion itr,cdulcd Tribes (Uttar Pndesh) order' 1967' - -- ir'" i""iiiiril." tc"a. Daman and Diu)schcdulcd Casrc Ordcr' 1968 ^ The Constitution (Coa Danran and Diu)Schedulcd Tribes-Ordcr' l96E' The Constitution (NaSaland)Schcduled Tribes Ordff' 1970' iiii -onrtitution isiL-tim)schcduled castcs ordo, 1978' ii" constitution isitkim) Scheduled Tribes order, I978 ii" ciitiiirii". ii.t cduicd case)(Amendmcnt) Act ordcr' 1990' ii" ii"tiii"ti"" is"hrdulcd Tribes)(Amcndmcnt) Act ordcr' t?61' .^^.
il Effi;;;;; iilJul.a r;tctiist"ond Amendment) Ad ordcr' leel' Thc Constitution (Schcdulcd Trib.) ordin8n*, 1996' il; ;;;;;;;;ai;; iilhedulcd castc'ana Schcd;lcd rribes) ordcr Amendment Act' 2002' it'" i"iiii,"ii"" is"hcdulcd castes order Amendment Act' 2002' irr" ioni i.,ion is"ftcdulcd castcs order (sccond Amendment Act' 2002 Shri/ Shrimati/ Kumari+ .. .
ln Tehsil "" " ' This Certificate is issued on the basis of followin
(t)
(2)
(3) v ordinarily reside (s) in village/Town ........ of District ofthe State of Gujarat' .. and his famil g credentials:- Seal Note:- The term "Ordinarily reside (s)" used shall have the same meaning as assigned to i!-in section 20 ofthe Repiesentation ofthe PeoPle Act' 1950'
PART.IV.B ] GUJARAT GOVERNMENT GAZETTE, EX. Ig-Og.2O2O FORMC lsee rule 6 (1)l Name of the District... ...
Name of the Competent Authority 331-t3 For*r for Register to be rnaintained by the cornpetent Authority showing the deta s orthe Scheduled Tribe Certificate issued to the aiplicant.
Remark ( r2)
(r) Sr No Sr No. of (he applicant io the register of application
(2) Scheduled Tribe certificate issued or denied
(3) Name of persoo lo r?hom the caste certificate has becn issued
(4) (5) Sr.
no in the list of Sche duled Tribe s
(6) Name of the Tribe
(7) Addre ss
(8) age' ta lu ka vi Sched ule d Tribc Certificat e No.
(e) Date of issuance of Schedule d Tribe Certifica te ( t0) Signature and name of Competent Authority (|) 33 i-14 GUJARAT GOVERNMENT GAZETTE, EX. 19.09-2020 FORMD lsee rule 10 (2)l I PART-IV-B Fom of application to be subrnitted to the Scheduled Tribe Certificate Scrutiny Comtnittee ior verification of Scheduled Tribe Certificate To, The Member-SecretarY, Scheduled Tribe Certificate ScrutinY Committee Subject: Scrutiny and veritication of Scheduled Tribe Certificate' Sir, I, the undersigned intend to verifY the Scheduled Tribe Certificate (Claim) for support of mY Scheduled purpose. I am submitting followlng information and docurnents in Tribe Claim. The original certificate may please by retumed to me after its scrutiny and verification.
Full nalne ofthe aPPlicant:
Present Address;
Village/Town/City, Taluka and District ;
Name of the Post office ;
Phone number :
Full narne ofthe applicant's father and permanent address (in case, the father is not alive, the permanent address of the father at the time of his death to be rnentioned) :
Present occupation ofthe applicant father with address and phone number :
If father is serving, post held and address of the employer with phone number :
fatl.rer's education :
faniily's traditional occuPation :
Scheduled Tribe/Sub-Tribe/Part or Group of tribe claimed by the applicant:
2
3.
4.
5.
6.
7.
10.
I l.
13.
l4 9 GUJARATGOVERNMENTGAZETTE,EX. 19-09.2020 33I.I5
(a) Applicant mother tongue :
(b) Dialect :
(c) God./Goddess :
(d) five sumames of the applicant,s relatives/community :
(a) Applicant's Original place, post, Taluka, District.
(b) If The Place has left, when who and why it was left.
(c) The name of the place (Village/Town/ City, Taluka and District where Applicant's father/grand-father was residing as on 6th september, 1950 of presidential order.
(a) since when the applicant is staying at the present address and the reasons for leaving original place.
(b) At present who is staying at the permanent place, his address and phone number.
(c) is there a hbuse, land at the native place.
!{) in case of land, dose extract of 7/12 whichcontain the entries under sections 73A, 73AA of the Gujarat Land Revenue Code, 1g79.
The authority from whom the applicant has obtained his Scheduled Tribe Certificate, Number and date of the certificate.
The Documents on the basis of which the applicanr has obtained Scheduled Tribe Certificate from the Competent Authority.
Name of the faculty, year, name of the educational institution, where the applicant is presently studying, address with Phone number.
Information of the educational institution where the applicant has studied.
Stages of Education, Name of the educational institute, period of Education, ( | ) lnstitution and address.
(a) Primary Education (give Information right fron lst std.) :
(b) Secondary Education :
PART-IV-B l '8.
12.
331-16 GUJARAT GOVEP.NMENT GAZETTE, EX. I9.Og-2020 [ PART.IV.B
(c) College Education :
15. Information ofthe educational institution, where the applicant's father has studied.
Stages of Education, Name of the educational institute, Period of Education, ( l) Institution and address
(a) Primary Education (give Information right from lst std.):
(b) Secondary Education College Education :
16. (a) Name of the applicant's Family (i.e. father, uncle, elder brother, sister, real uncle), who have taken Education.
(b) out ofthe above member has any one obtained Scheduled Tribe Certificate and have they availed the benefits ofthe Scheduled Tribe?
If yes, when and how.
17. (a) Is scheduled tribe certificate of any member of the family has been verified before this? ifyes, Name of the family member, relation With the applicant and when and For whatl the verihcation was done.
(b) If Validity Cetificate has been obtained, give its number and date. (enclose a copy)
18. Ifthe Scheduled Tribe, certificate (claim) is to be verified for the purpose of service give the Desi gnation of the Appointing Authority of the applicant, address and phone number.
(a) Date of selection :
PART-IV-B I GUJARAT GOVERNMENT GAZETTE, EX. Ig-Og-2020 331-17
(b) Date of promotion, if promoted :
(c) Address and phone number of the present office :
I 9. If the Scheduled Tribe, Certificate (claim) is to be verified for the purpose of service give the information ofelection.
(a) Type of election and place, Taluka, district.
(b) Date of election .
(c) Name and number of the constituency.
20. Following documents (original certificate and its attested copies should be enclosed
(a) Original documents
(l) Scheduled Tribe Certificate ofthe applicant with attested copy.
(2) Affrdavit.
(b) Attested copies of following document in respect ofapplicants particurars :-
(1) Primary school leaving cefiificate.
(2) An extract of school admission register.
(3) An extract of birth and death register.
(c) Attested copies of following document in respect ofapplicant,s father :- ( I ) Primary school leaving certificate.
'
(2) An extract of school admission register.
(3) An extract of birth and death register.
(4) Scheduled Tribe Certificate in the prescribed form.
(5) If in service, extract offirst page/pages ofhis service record (book) showing his Scheduled Tribe.
(6) If father is illiterate, the primary school leaving certificate of the real elderly blood relatives of the applicant and extract of school admission register.
(d) Other documentsl.Revenue record like, an extract of 7/12 or revenue, birth regisrer; sale deed, Record of rights (Village form no. 6)containing entries of 73A/73AA ofthe Gujarat Land Revenue Code,1879 etc.
331- l 8 GUJARAT GOVERNMENT G AZE"TTE, EX. 'I9-09'2020 [ PART'IV'B
2. Affidavit ofthe nearest relatives from the paternal side whose ValidityCertificateareSubmittedinsupportoftlreScheduledTribeclairn of the aPPlicant ;
3.AnAffidavitdulyexecutedbytheapplicantStatingtheinformation about any Cetificate of the patemal side held valid or invalid with details thereof ;
4. Any other relevant evidence/documents' in support of the applicants Scheduled Tribe Certifi cate (claim)' If any one ofthe above document is not available, state reasons for non availability of the documents. ... . .
PIace:
Date:
Yours, (Signature of the APPlicant) (Signature of the appticant's father/guardian) Ihavesubmittedtheoriginaldocumentsandtheirattestedcopiesasabo.ve,.alongwith the application for verification. ideclare on oath, in wdting, that the informatio' furnished in the uppti"ution form by me is true and correct to the best of my knowledge and belief'
PART-rV-B l GUJARAT GOVERNMENT GAZETTE, EX. I}.O9.2O2O F'ORM E
(1)
(2) Signature Qrlame of the applicant) *Strike out which is not applicable 33 t-19 For-m oran arndavit. ,. *yr*=l,'ri::::i::r'!:::itree with the rorm orapprication rorverification of the Scheduled friUe Cenii,cate;ili";;;H", ffii::Hiffi;:i.Tfl1: validation/invalidation of fouowing relatives from paternal side are As mentioned above, a genealogical tree showing the relation with the relativewhose validity certificates are enctosea iittr ,t.'"rpff""rl"".
All the documents fumished along. with an application fqrm and the informationfumished in the application form, are true and corect to the best of my knowledge and belief.
by the I belong to _scheduled Tribe. IScheduled tribe Ce-nificate No have applied for verification of my GUJARAT GOVERNMENT GAZETTE, EX. 19-09.2020 FORM F lsee rule 11 (l) | I PART-IV-B Form for Register to be maintained by the Member Secretary to register application for verificalion received Sr.
No.
Name of the applicant Caste Cenificate no. issued by the Competent Authority Date of issuance of Caste Cenificate by the Competent Authority Name of Taluka Name of District Date of receipt of application for scrutiny Date of disposal of application Particulars about disposal of application Signarure of the Mernber Secretary Approval Rejection I 4 5 6 1 8 9 l0 II 33r-20 2
PART-IV-B ] GUJARAT GOVERNMENT GAZETTE, EX. 1g-Og.2O2O FORMG [see rule It (7) and t] (9) (a)l GOVERNMENT OF GUJARAT TRIBAL DEVELOPMENT DEPARTMENT SCIIEDULED TRIBE CERTIFICATE SCRUTITW COMTTTTTN VALIDITY OF' CERTIF'ICATE 33t-21 Photograph of the Appticant Case No Sr.No Date. .. ... . ..
Shri/Smt/Kum After considering the documents and associated facts it is cerrified that belongs to the ribe.Therefore, his Scheduled Tribe Dated rhe...... ..........2020 IS found vajid by rhe Scrutiny Committee certificate issued by bearing no the CompetentAuthority... ... ....
District...........
Place :- Member-Secretary.
Signature :- Q.lame:................
) Seal FORMH lsee rule tl (9) (a)l Register showing the details of the validity certifrcate issued by the Scheduled Tribe Certilicate ScrutinY Committee' Serial No.
VillaBc taluka Nanrc of pcrson to \ trom lha validiry cadficatc has bean issucd I 2 Sr No. of thc aDplicalion in the rcgistar of spplicatiol'r 4 Address 5 Schcduled Trib.
Ccrtificatc No.
6 Validity CG{tificrt!
No.
1 of the tribe Sr No. ilr thc list of Sclrcduled Tribes 9 Due of issuancc of Sch.dulod Tribcs ValiditY Ccrtiticrtc l0 Signaturc and namc of the Compelcnt AuthorirY ll By order and in the name of the Govemor of Gujarat' Joint SecretarY to Government' Copy to:- IPART-rV-B 331-22 GUJARAT GOVER"\MENT GAZETTE, EX. 19'09'2020 . The Principal Secretary to the Hon'ble Governor of Guiarat' Raibhavan' . illTjlillj, Secretary to the Hon,bre chiefMinister ofGuiarat, swarnim Sankul-1, . l1?lfllllirlllj"" l; the Hon,bre Deputy chier Minister or cujarat, swarnim Sankul-1, Sachivalaya' Gandhinagar' o The Personal Secretary t"'tn" *"'O* Minister' Tribal Developmen! Swarnim Sankul'1, Sachivalaya' Gandhinagar' . The Personal Secretary tJ" i""'Uf" Minister of State for Tribal Development' Swarnim Sankul-2, Sachivalaya' Gandhinagar' o The personal Secretary ;-;i;i;**,;y, Block No'1, 5s Floor' Sachivalava' Gandhinagar.
t
PART-IV-B l GUJARAT GOVERNMENT GAZETTE, EX. I9-09-ZO2O FORMH lsee rule 1I (9) (a)l Register shorving the details ofthe validity certificate issued by the Scheduled Tribe Certifi cate Scrutiny Committee.
By order and in the name of the Govemor of Gujarat, 331-23 J. R. DODIYA, Joint Socretary to Government.
Serial No.
Villagc taluka Namc of whom $c Ialidity cenificatc has been issued Sr No. ofthe applic.tion in thc rcgist rof application Scheduled Tribe Cenificate No.
Validity Ccrtificsrc No.
Nahe of lhe tsibc SrNo. in thc list of Schrdul.d Tribcs Date of issuarce of Scheduled Trib€s Validity Certificate Signtlrrc rnd nlnrc oftha ComFtcnt Authority I 2 4 ) 6 '7 8 9 IO ltIIIIT IIIII Govemment Central Press, Gandhinagar.
_t]