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GOVERNMENT OF KARNATAKA

REVENUE DEPARTMENT

FORM-D

Scheduled Caste/Scheduled Tribes Certificate

Certificate No: RD0038186129648 *RD0038186129648*

This is to certify that Smt. VASANTAMMA W/O Sri. SANTHANAM(Husband Name)and
D/O Smt. SAVITHRAMMA (Mother Name)is a resident of NO 130 2ND
CROSS SIDDARTHA LAYOUT KAVAL BYRASANDRA, in B.B.M.P(Ward-32 )Ward, Bengaluru North
Taluk, Kasaba-1 Hobli, Bengaluru District, in the state of Karnataka, belongs to the Caste / Tribe*
Scheduled Caste(Adi Karnataka) which is recognized as Scheduled Caste/Scheduled Tribe under :-.

* The Constitution (Scheduled Castes) Order, 1950

* The Constitution (Scheduled Tribes) Order, 1950
* As Amended by the Scheduled Caste & Scheduled Tribes lists (Modification) Order, 1956 and The Scheduled Castes &
Scheduled Tribes Orders (Amendment) Act, 1976.
* The Constitution (Scheduled Castes) Order (Amendment) Act, 2019.

Smt. VASANTAMMA W/O Sri. SANTHANAM and / or his/her family are

ordinary resident (s) in B.B.M.P(Ward-32)Wardof BengaluruDistrict of the State of Karnataka.

This certificate is valid for life time

Date:10/07/2019
Note : This is a digitally signed certificate and does not
require manual signature.

Please, verify authenticity of this certificate by visiting Name: MAHENDRA

www.nadakacheri.karnataka.gov.in & entering Tahsildar
certificate Number or by SMSing KA NK <certificate Bengaluru North Taluk
Number> to 161. Bengaluru District

This Certificate can be Verified atwww.nadakacheri.karnataka.gov.in Ver:4.1

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