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2120004
FORM - 8
[Rule No. 50)
Form of Caste Certificate for De-Notified Tribe (Vimukt JatiyNomadic Tribe/Other Backward
(Class/Special Backward Category person belonging to the State of Maharashtra
Documents Vertied
‘.. Bonale Cereicae (7E Ha.)
{Copy of Schoo! Leaving Ceruncate or Famer
FATHER UD
Copy ol Schoo! Leaving Certieste Ot Grandtather
‘Self Declaration
CASTE CERTIFICATE
Outward No = aoaedonsat Date 127122017
ae MRC + 40404000411
‘This isto certify that Kumar Devashish Chintaman Bhagatson of Shri Chintaman Chandulal
Bhagat of Vilage Bajartola, Tehsil Gondiya, in the District Gondlya ofthe State of Maharashtra
belongs to the Powar Caste which is recognised as Other Backward Class at Sr No. 189 under
Government Resolution CBC-1470/1939-D-6 dated 26/07/1976 as amended from time tote.
Kumar Devashish Chintaman Bhagatand’ or hs family ordinarily resides in Village Bajartota,
“Tehsil Gondiya, in the District Gondiya of the State of Maharashtra,
‘Signature valid
“Me th
Date: +2017 [Link]
‘Sub Divisional Officer
Gondia
‘ue gal gna eocment hence Wg vada pe he tema Tach At 200
“To ety vt os mahaoice or. ery OF SMS WHspace-CSC apace VRE Og Broce AIRE 46 Pam 8 BON, MTL, Te Mom
1068 tom anes,
