PRE/POST METRIC SCHOLARSHIP PURPOSE ONLY

FORM OF CERTIFICATE
Misc Case No. . / Dt.

This

is

to

certify

that

Sri/Kumari

... Son/Daughter of

of

village

in the district of Angul in the state of Odisha belongs

to

Tribe which

is recognized

as SC/ST under

Constitution (SC Order 1950 Constitution ST Order 1950 amended by the SC/ST
amended order 1976).

Sri/Kumari . and his/her family ordinarily reside

in Village

., PS ., Dist-Angul in the

state of Odisha and his religion is . .

Place
Date

WELFARE EXTENSION OFFICER,

CHHENDIPADA