S/T
CERTIFICATE.
To,
The Deputy Commissioner,
East Siang District, Pasighat.
Dated Pasighat the
_______________________________
Sub
:- Application for issuing S/T
certificate in respect of
Sri/Smti/Miss_____________________________________
Sir,
I
have the honour to inform you that I am in need of S/T Certificate for same
work for which necessary particulars in respect are furnished below :
1. Name
(in block letter) :
2. Father’s
name :
3. Permanent
Address :
4. Caste/Community/Tribe :
5. Purpose for which the S/T :
Certificate is required.
6. Nationality :
7. Religion :
8.
2
(two) passport photo attested
by any Gazzatted Officer. :
Your’s faithfully,
( )
VERIFICATION BY
ADMINISTRATIVE OFFICER.
I have verified the
particulars of the applicant and satisfied that
Sri/Smti/Miss_______________________________________
belongs/does not belongs to ______________________
tribe which is a recognised scheduled tribe of
Arunachal Pradesh. I recommend that an S/T certificate may be issue to him/her.
Signature of Administrative Officer
(
with
seal )
N.B. : The
concerned administrative Officers should verified the tribe to be this complete
satisfaction. If need he can get verification from H. Gam
Burah and
public leaders.