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T. NO.
CASTE CERTIFICATE
SR. NO.
MAHARASHTRA
OTH. STATE
First Name
Middle Name
Last Name
First Name
E-mail :
Middle Name
Last Name
Ph./Mob.:
Village :
Present Address :
Caste : SC / ST / VJ / NT / OBC / SBC / MARATHA
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ST
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NT
10-08-1950
06-09-1950
21-11-1961
21-11-1961
13-10-1967
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Govt. of Maharashtra, Stamp Duty Waiver Order No. Mudrank 2004/1636/PK 436 /M-1, dated 1/7/2004
AFFIDAVIT FOR
Family Tree
The information given in this affidavit and the application are true to the best of my knowledge and belief. If
this information is found to be false later, I am aware that I would be liable for all actions and consequences
under sections 193(2), 199 and 200 of the Indian Penal Code.
Witness:
Signature Name Address No. R/ ________________ Date ________________
Solemnly affirmed and signed before me by
Shri./Smt. ___________________________________
who is identified by Shri./Smt._______________________
whom I know personally.
Executive Magistrate
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