GOVERNMENT OF MEGHALAYA

APPLICATION FORM FOR ISSUANCE OF RESIDENCE CERTIFICATE

Application Processing Location:-

Applying to: *

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Office of the Deputy Commissioner

Office of the 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/Sub Division choosen above

A. Applicant Details

Title *

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Applicant's Full Name *

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Alias (If Any)

Gender *

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Male

Female

Others

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Date of Birth *

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Place of Birth *

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Mobile Number *

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E-Mail

Nationality *

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Date from which applicant is residing in State / District *

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EPIC No.

Passpost Size Photo(Attach photo of size 20kb to 100kb) *

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Whether staying in rented house? *

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Yes

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Name of 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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Are either of your parents a government servant? *

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Yes

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Community the applicant belongs to? * e.g Khasi, Garo, Jaintia, Bengali, etc

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Purpose for applying for Residential Certificate *

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Others (purpose) * Please mention the Specific Purpose for requirement of the Certificate to help the Authority for quick issuance.

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Do you have any certificate issued from this office? * If you have any certificate like Caste/Tribe/PRC/etc obtained from this office,please upload for quick processing of your application

If you have any certificate like Caste/Tribe/PRC/etc obtained from this office,please upload for quick processing of your application

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Yes

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B. Present 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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Pincode

C. Permanent Address

Same as 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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Pincode

D. Parent's Details

Title *

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Father's Full Name *

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Father's Nationality *

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Title *

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Mother's Full Name *

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Mother's Nationality *

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Guardian's Title

Guardian's Full Name

Self / Parent / Guardian EPIC No. *

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Declaration:

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

I Agree *

# All enclosure documents that are to be uploaded needs to be scanned completely on both sides (e.g Both sides of an EPIC)

# 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.

#Upload coloured photographs only