GOVERNMENT OF MEGHALAYA

APPLICATION FORM FOR SCHEDULED TRIBE CERTIFICATE

Application Processing Location

Applying to: *

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Office of Deputy Commissioner

Office of Sub Divisional Officer

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State*** *

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District *

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Sub Division *

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Application would be processed according to the District or Subdivision selected here*** *

A. Applicant Details

Title * Choose Applicant's Salutation

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Applicant's Full Name * Enter Applicant's full name

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Gender *

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Male

Female

Others

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Previous name (if changed)

Alias(if any)

Maiden Name / Birth Name (if any)

Date of Birth * Select or write DOB in dd/mm/yyyy format

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Age *

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Place of Birth

Tribe * Select your tribe

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Sub Tribe *

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Nationality *

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Kuki Sub Tribe *

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Religion *

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Other Religion *

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Mobile Number * Please enter mobile number for necessary communication

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E-Mail

Photograph(Upload photo size of 20kb to 100kb) * Upload photograph of good quality

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EPIC No. of Applicant

Whether staying in Rented House? *

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Yes

No

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Name of the House Owner *

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Present Occupation: *

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Name of Organization *

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Designation *

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Place of Posting: *

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B. Permanent Address

State *

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District *

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Village/Town *

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Locality *

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Sub-Locality

Nearest Landmark

Post Office *

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Police Station/Outpost *

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C. Present Address

Same address as above Tick to copy the same address written above

Yes

State *

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District *

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Village/Town *

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Locality *

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Sub-Locality

Nearest Landmark

Post Office *

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Police Station/Outpost *

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D. Parents/Guardian Details

Title * Father's Salutation

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Father’s Name in Full * Enter applicant's Father's Name in full

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The Community of Father *

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ST

SC

General

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Father's Nationality *

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Other Nationality(Father) *

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Caste/Tribe of Father *

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Father Religion *

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Other Religion(Father) *

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Title * Mother's Salutation

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Mother’s Name in full * Enter applicant's Mother's Name in full

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The Community of mother *

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ST

SC

General

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Mother's Nationality *

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Other Nationality(Mother) *

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Caste/Tribe of Mother *

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Mother Religion *

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Other Religion (Mother) *

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Title

Guardian's Full Name Enter applicant's Guardian's Name in full

Self/Father's/Mother's/Guardian's EPIC No. *

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Migration and Adoption Details

Whether Adopted ? *

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Yes

No

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Have your parents migrated to Meghalaya from another State? *

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Yes

No

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Annexure I (Migration Details)

Kindly fill the details of the migrated parent on whose behalf the applicant is claiming to be ST?

The applicant is applying for ST certificate based on whom? *

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Father

Mother

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State/UT *

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District *

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Village/Town *

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Locality *

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Tribe *

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Certificate No. *

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Scheduled Tribe Issuing authority *

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Certificate Issue Date *

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Details of Adoptive Parents

Title *

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Father's Name *

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Caste/Tribe(Father)

Religion(Father)

Title *

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Mother's Name *

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Caste/Tribe(Mother)

Religion(Mother)

State *

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District *

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Village/Town *

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Locality *

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Declaration

This is to certify that the information furnished as above are true to the best of applicant's knowledge and belief and that the applicant would be liable for prosecution if found otherwise.

I Agree *

# All enclosures that are to be uploaded needs to be scanned completely on both sides (e.g Both sides of an EPIC needs to be uploaded as one document) preferably as .pdf

# Two or more documents may be scanned together to form a single document. This may be done if the applicant wants to submit more documents for proof.

# Xerox copies of documents to be self attested before uploading.

# Only colored passport size photograph to be uploaded.