Annexure – 1

Letter from Government of Telangana & Rule of Reservation for Admission as

per the Presidential Order 1974
Seats will be reserved, to the following categories in Admissions to Professional Courses:

1. Reservation in State-wide Universities (as per Presidential Order 371 Article D in

consonance to Section 95 of the A.P. Reorganization Act, 2014 ( Lr. No:
1959/TE/A2/2015-2, dated 29-04-2015):

The admissions to 85% of the total available seats shall be reserved for the Local
Candidates (Osmania University area, TS) and the remaining 15% of the seats shall be
un-reserved (these seats can be filled with both States Telangana and Andhra Pradesh
students based on merit) as specified in the Presidential Order 371 Article D in
consonance to Section 95 of the A.P. Reorganization Act, 2014.

(A) Local Areas Means:

i. The part of the State comprising the districts of Adilabad, Bhadradri Kothagudem,
Hyderabad, Jagtial, Jangaon, Jayashankar Bhoopalpally, Jogulamba Gadwal,
Kamareddy, Karimnagar, Khammam, Komaram Bheem Asifabad, Mahabubabad,
Mahbubnagar, Mancherial, Medak, Medchal, Nagarkurnool, Nalgonda, Narayanpet,
Nirmal, Nizamabad, Peddapalli, Rajanna Sircilla, Ranga Reddy, Sangareddy, Siddipet,
Suryapet, Vikarabad, Wanaparthy, Warangal (Rural), Warangal (Urban), Yadadri
Bhuvanagiri shall be regarded as the Local Area for the purpose of admission to the
Osmania University, the Kakatiya University, Telangana University, Mahatma Gandhi
University, Palamuru University and to any other educational institutions (other than
a state-wide university or state-wide educational institution) which is subject to the
control of the State Government and situated in that part.

(B). Local Candidate means:

1. A candidate for admission shall be regarded as a Local Candidate in relation to a

local area (Osmaina University Area, Telangana State).
1.1 If he/she has studied in an educational Institution or educational institutions in
such local area for a period of not less than four consecutive academic years
ending with the academic year in which he/she appeared or first appeared in the
relevant qualifying examination, as the case may be, (see Annexure - II)or
1.2 Where, during the whole or any part of the four consecutive academic years
ending with the academic year in which he/she appeared or, as the case may be,
first appeared for the relevant qualifying examination, he/she has not studied in
 any educational Institutions, if he/she has resided in that local area for a period
of not less than four years immediately preceding the date of commencement of
the relevant qualifying examination in which he/she appeared or first appeared,
as the case may be (see Annexure – III) .
2. A candidate for admission to the Course who is not regarded as local candidate
under clause (A) above, in relation to any local area shall,-
2.1 If he/she has studied in educational Institutions in the State for a period of not
less than seven consecutive academic years ending with the academic year in
which he/she appeared or first appeared for the relevant qualifying examination,
as the case may be, be regarded as a local candidate in relation to,-

(i) Such local area where he/she has studied for the maximum
period out of said period of seven years, or
(ii) Where the period of his/her study in two or more local areas is
equal, such local area, where he/she has studied last in such
equal periods. (see Annexure – II)

2.2 If, during the whole or any part of seven consecutive academic
years ending with the academic year in which he/she appeared or first
appeared for the relevant qualifying examination, as the case may be,
he/she has not studied in the educational institutions in any local area,
but has resided in the state during the whole of the said period of seven
years, be regarded as a local candidate in relation to,-
(i) Such local area where he/she has resided for the maximum period out of the
said period of seven years, or
(ii) Where the period of his/her residences in two or more local areas are equal,
such local area where he/she has resided last in such equal periods. (see
Annexure – III)

(C). The Non-Local Candidate means

1. Candidates coming under any of the categories given below and not satisfying the
conditions mentioned in 1 or 2 above are treated as Non-Local to Osmania
University Area
(a) candidates who have resided in Telangana and Andhra Pradesh States for a
total period of 10 years excluding periods of study outside in Telangana and
Andhra Pradesh States (see Annexure – IV)or

(b) Candidate’s either of whose parents have resided in Telangana and Andhra
Pradesh States for a total period of ten years excluding the period of
employment outside in Telangana and Andhra Pradesh States(see Annexure –
IV) or
 (c) Candidates who are children of parents who are in the employment of in
Telangana and Andhra Pradesh States or Central Government, Public Sector
Corporations, Local Bodies, Universities and other similar quasi-public
institutions, within the state, at the time of submitting the application (see
Annexure – IV) or

(d) Candidates who are spouses of those in the employment of the state or
Central Government, Public Corporations, Local Bodies, Universities and
Educational Institutions recognized by the Government or University OR other
competent authority and similar quasi Government Institutions within in
Telangana and Andhra Pradesh States, at the time of submitting the
application (see Annexure – IV).

3. If a local candidate in respect of a local area is not available to fill any seat reserved
or allocated in favour of a local candidate in respect of that local area, such seat shall
be filled if it had not been reserved.
4. Candidates who claim reservation under any of the categories mentioned above
shall enclose copies of relevant certificates. The respective proformas are available in
the Annexure -2.

NOTE: For details, see the Andhra Pradesh Educational Institutions (Regulations of
Admission) Order, 1974 as subsequently amended (G.O.No.646. dated 10.7.1979).

2. Reservation for SC/ST/BC Communities:

(See Annexure – V)

(a) 15% of seats shall be reserved for the candidates belonging to scheduled Castes.
(b) 6% of seats shall be reserved for the candidates belonging to the scheduled Tribes.
The seats reserved for scheduled Tribes shall be made available to scheduled
Castes and Vice-versa, if qualified candidates are not available in the category.
If qualified candidate belonging to Scheduled Castes and Scheduled Tribes
communities are not available the left over seats reserved for them shall be treated
as unreserved seats and shall be filled by candidates of General Pool.

(c) Seats shall be reserved for the candidates belonging to the Backward Classes and
shall be allocated among the following groups of Backward Classes as shown below:

GROUP ‘A’----- 7%, GROUP ‘B’ ----- 10%, GROUP ‘C’ ----- 1%,
GROUP ‘D’ ----- 7% and GROUP ‘E’ ----- 4%

If qualified candidates belonging to Backward Class of a particular group are

not available, the leftover seats can be adjusted for the candidates of next group. If
qualified candidates belonging to Backward Classes are not available to fill up the
 seats reserved for them, the left over seats shall be treated as unreserved and shall
be filled up with candidates of General Pool.

No candidates seeking reservation for admission under above categories be

allowed to participate, in the Counseling for admission unless he/she produces the
integrated Community Certificate prescribed by the Govt. and issued by the Revenue
Authorities in the Government (vide G.O. MS. No: 58, Social Welfare (J), Dept.,
Dated: 12-5-1997)

III. Reservation of seats for women:

A (horizontal) reservation of 33 1/3 % of seats in favor of women candidates in each

category (OC/SC/ST/BC/Special Categories) shall be followed.

The above reservation shall not be applicable if women candidates selected

on merit in each category exceed 33 1/3%.If sufficient number of women candidates
are not available in the respective categories those seats shall be diverted to the
men candidates of the same category.

IV. Reservation for Special Categories:

(See Annexures – VII & VIII)

(a) Seats shall also be reserved for the following categories, to the extent indicated
against them,

i. Physically Handicapped (PH) – there shall be 3% (three percent)

horizontal reservation in each category (OC, BC, SC, ST) for Visually
handicapped/ hearing impaired/ Orthopedically Handicapped (each 1%)
(One percent).
ii. Children of Armed Forces Personnel (CAP) -2% (two percent) for the
children of armed persons i.e. Ex-Servicemen, Defense Personnel
including the Children of Border Security Force and the Central Reserve
Police Force residing in Telangana for a minimum period of 5 years.
iii. National Cadet Corps (NCC) – 1% (one percent) horizontal reservation for
National Cadet Corps candidates.
iv. Sports and Games (SP) – ½% (half percent) horizontal reservation for
sports and Games candidates.

If qualified candidates belonging to PH/CAP/NCC/SP/ Categories are not available,

the left over seats shall be filled up with candidates of General Pool of the same local area.
Note: The candidates claiming reservation benefits under the above categories shall
produce original documents in support of their claim to the Convener of Admissions and he
shall be entitled to get them scrutinized/verified and also refer the original document of the
candidates claiming reservation for scrutiny and confirmation, to the following authorities.

(i) PH - Director, Medical & Health Services, Telangana

(ii) CAP - Director, Sainik Welfare Board, Telangana/A.P.
(iii) NCC - Director of NCC, Telangana/A P
(iv) Sports & Games - Vice-Chairman and Managing Director, Sports Authority of
Telangana/A.P. (SAAP)

The priorities in respect of the special categories mentioned above shall be in

accordance with Government Orders issued from time to time.
Note: For Formats of Certificates to be produced by the Candidates at the time of
counseling, pl. see Annexures II to V
 Annexure – II
(to be submitted by all applicants)
STUDY CERTIFICATE IN SUPPORT OF LOCAL STATUS
Details of study of the Applicant for the last Seven Years preceding the year of passing the
qualifying examination
(See I.B.1.1 and I.B.2.1 of Annexure – I)
The following are the Schools, Years and Places where I studied from my
fourth class to tenth class

Sno Class Year School Place District

1 Tenth

2 Ninth

3 Eighth

4 Seventh

5 Sixth

6 Fifth

7 Fourth

The above information is true to the best of my knowledge. I will take the responsibility for
any lapse in the above information and forego my seat. I enclosed all the relevant study
certificates.

Signature:
Name of the Applicant:
Address:
___________________________________________________________________________
___
 ANNEXURE-III

RESIDENCE CERTIFICATE IN SUPPORT OF LOCAL STATUS

(See I.B.1.2 and I.B.2.2 of Annexure – I)

1. It is hereby certified:
a. That Mr/Kum
__________________________________________________________________
_____________ son/daughter of Sri/Smt.
__________________________________________________________________
________________ a candidate for admission to the RGUKT First Year course,
appeared for the first time for the
__________________________________________ examination (being the
minimum qualifying examination for admission to the course mentioned above)
in _____________ (month) ________________ (year).

b. That in the 10 years, immediately preceding the commencement of the aforesaid

examination he/she has resided in the following place/places falling within the
area in respect of the OU region (studied in Telangana State).

S.No. Period Village Mandal District

1
2
3
4
5
6
7

2. The above candidate is, therefore, a local candidate in relation to the area specified in
Paragraph 3(1)(2)(3) of the A P Educational Institution (Regulation of Admissions) Order
1974 as amended.

Officer of the Revenue Department

(Issued by the competent authority of Revenue Dept.)
Date:
(OFFICE SEAL)
 ANNEXURE-IV

CERTIFICATES IN SUPPORT OF NON-LOCAL STATUS

(A) Certificate to be furnished when the candidate has resided in the state for a period of
10 years
(Read Instructions under (I.C.1.a) of Annexure (I))

This is to certify that

Mr./Kum.___________________________________________________________________
_________________________ Son/Daughter of
Sri./Smt.____________________________________________________________________
____________________________ an applicant for admission to the first year of 6-Year
Integrated B. Tech programme (2020-21), is a resident of
_________________________(Place) in__________________________________(District)
of Telangana / Andhra Pradesh for a total period of 10 years from the
year________________________to_______________________________excluding the
periods of study outside the state.

Place:
Date:
Signature of the competent
Authority from Revenue Dept.
Office Seal:

(B) Certificate to be furnished when either of the parents of the candidate has resided in
the state for a period of 10 years
(Read Instructions under (I.C.1.b) of Annexure (I) of Instruction Booklet of admission)

This is to certify that

Mr./Kum.___________________________________________________________________
_________________________ Father/Mother of
Sri./Smt.____________________________________________________________________
____________________________ an applicant for admission to the first year of 6-Year
Integrated B. Tech programme (2020-21), is a resident of
_________________________(Place) in__________________________________(District)
of Telangana / Andhra Pradesh for a total period of 10 years from the
year________________________to_______________________________excluding the
periods of study outside the state.

Place:
Date:
Signature of the competent
Authority from Revenue Dept.
Office Seal:
 (C) Certificate to be furnished when the parent/spouse is an employee of the State or
Central Government or Quasi-Government organization.
(Read Instructions under I.C.1.c) and 3(d) of Annexure (I) of Instruction Booklet of
admission)

This is to certify that

Sri/Smt_____________________________________________________________________
_______________________ Father/Mother/Spouse of
Mr/Ms_____________________________________________________________________
_________________________________ an applicant for admission to the first year of 6-
Year Integrated B. Tech programme (2020-21), is presently employed in Telangana /Andhra
Pradesh States in the Organization ____________________from ___________________till
to-date. This Organization is a State/Central/Quasi Government Organization in the State of
Telangana/AP.

Place:
Date:
Signature of the Issuing Authority
Designation:
Office Seal:
 ANNEXURE- V

COMMUNITY, NATIVITY AND DATE OF BIRTH CERTIFICATE

REVISED PROFORMA AS PER G.O.Ms.No.58, SOCIAL WELFARE (J) DEPT.DATED 12.05.1997

A P GAZETTE EXTRAORDINARY PART-I
Serial No. FORM III
S.C. District Code:
S.T. Emblem Mandal Code:
B.C. Village Code:
Certificate No.:

COMMUNITY, NATIVITY AND DATE OF BIRTH CERTIFICATE

(Integrated Community Certificate)

1. This is to certify that

Sri/Smt./Kum_____________________________________________________________
_______________________ Son/Daughter of
Sri______________________________________________________________________
__________________________ of
Village/Town_____________________________________________________________
_______________________________________
Mandal__________________________________________________________________
_District of the state of Telangana / Andhra Pradesh belongs to
_________________________________________________ Community which is
recognized as SC/ST/BC under:
The Constitution (Scheduled Castes) Order, 1950
The Constitution (Scheduled Tribes) Order, 1950
G.O.Ms.No. 1793, Education, dated 25.09.1970 as amended from time to time BCs, SCs,
STs list (Modification) Order1956, SCs and STs (Amendment) Act, 1976.

2. It is certified that
Sri/Smt./Kum.____________________________________________________________
__________________________ is a native
of_____________________________________________________________District of
Telangana / AP.

3. It is certified that the place of birth of

Sri/Smt./Kum.__________________________________
Village/Town_________________________
Mandal_____________________________________ District of Telangana / AP

4. It is certified that the date of birth of Sri/Smt./Kum.______________________is

Day__________Month___________Year______________ (in
 words______________________) as per the declaration given by his/her
father/mother/guardian and as entered in the School records where he/she studied.

Signature:
Date:
(Seal) Name in Capital letters:
Designation:

Explanatory Note:
1) While mentioning the community, the competent Authority must mention the sub-
caste (in case of SCs) and Sub-Tribe of Sub-Group (in case of STs) as listed out in the
SCs and STs (Amendment) Act, 1976.
 ANNEXURE-VI

MEDICAL CERTIFICATE IN RESPECT OF PHYSICALLY HANDICAPED CANDIDATES

Medical Board constituted vide G.O.Ms.No. 109 Women’s Development child Welfare and
Labour Department, Dt. 15-6-1992 comprises the following.

1. Dr. Reg. No.

2. Dr. Reg. No.

3. Dr. Reg. No.

Certified that we have this……………………………………day of ……………………………….2015

examined the applicant whose particulars are given below and that he/she falls within the
above definition.

Name of the Candidate : Affix your latest

Father’s Name :
photograph
Sex :
Photograph (attested) to show if possible

Identification Marks:

1.

2.

Nature of the Disability: Tick at relevant from the following

and provide details

Visuals Defects

a) If the vision is from 6/18 and up to 6/60 and

anything less than 6/60 shall be considered
as an extreme handicap.

b) Visual activity not exceeding 6/60 or 2/20

(Shellen) in the better eye with correcting
lenses.

c) Limitation of the field of vision sub-tending

an angle of 20 degrees or less.

I) Orthopedically Handicapped:
 a) Both the upper limbs

b) Both the lower limbs

II) Loss of one eye/upper limb/lower

Limb (percentage of disability to be
mentioned)

III) Deaf persons who cannot hear

Without the help of hearing aid

IV) Crippled (Deformed in any part

Of the body other than legs and
Is disabled)

a) Any other particulars to clarify the

Nature or extent of disability that the
Board might like to point out.

b) Whether the candidate can attend

Day to day professional work & training.

Signature of the Candidate Signature of the Members of Board

1.

2.

3.

Seal of Hospital

Note: The Candidate with the following defects are not eligible for admissions into RGUKT:
(1) Mentally retarded, (2) Blindness (3) Deaf and Dumb (4) Chronic Heart, Lung, Kidney and
liver diseases, (5) Muscular Dystrophy.

Priorities under Physically Handicapped (PH) Category:

The priorities under this category shall be as per G.O.Ms.No. 130 HE (TE-1)
Department dated: 6.9.2000.
I) 3% horizontally for Physically Handicapped in each group i.e. O.Cs, B.Cs, S.Cs. S.Ts in
the following cyclic order.
i) 1% for visually handicapped.
ii) 1% for Hearing impaired.
iii) 1% for orthopedically handicapped.

Note 1: The above reservation shall be rotated in cyclic order as follows:

a) If candidates Visually Handicapped category are not available, the vacancy can
be filled up by the candidate in the category of hearing impaired.

b) In case of the hearing impaired candidates are not available, the vacancy can be
filled up by the candidates in the orthopedically handicapped category.

Note 2:
In case, qualified Physically Handicapped candidates not available for any category
among the three categories mentioned above, the unfilled vacancies shall be filled
with other candidates on the basis of merit in the respective category. (i.e.)
OC/BC/SC/ST.

Note 3:
The candidates with the following defects shall not be eligible for admission into
Engineering/Pharmacy courses:

a) Mentally retarded
b) Blindness,
c) Deaf and Dumb
d) Chronic Heart, Lung, Kidney, Liver diseases,
e) Muscular dystrophy
 ANNEXURE-VII
CERTIFICATE TO BE SUBMITTED BY THE CANDIDATE CLAIMING RESERVATION UNDER CAP
CATEGORY.

Proposed Revised Proforma certificate in the case of Children of ex-servicemen, Armed

personnel, BSF and CRPF

The Certificate should be signed by (1) Zilla Sainik Welfare Officer of the concerned District
in the case of Ex-Servicemen or by (2) the Officer in command of the unit in the case of
Serving Armed Forced personnel.
No.
On the strength of the Discharge Certificate/Service particulars of the Ex-
servicemen/Serving soldier and the Bonafide Certificate of the student this is to certify that
Sri/Kum. ______________________________________is the Son/Daughter of an Ex-
serviceman Ex.
No._________________________________________________Rank___________________
_____________ Name__________________________________ Corps
_______________________who has served in the Indian Army/Navy/Air Force in erstwhile
Hyderabad State Forces, with effect from_______________ to _________________ and was
discharged on account of ___________________with _______________ character (total
regular service on the date of discharge _________________years) He belongs to the
following CAP category as per G.O.Msc.No.192 Dated 26-8-1993 of Education (EC-2)
Department.

1) Children of Armed Forced personnel killed in action.

2) Children of Armed Forced personnel disabled in action and invalidated out from
service on medical grounds.
3) Children of Armed Forced personnel who are in receipt of Gallantry Award
(Mention the name of Award
_____________________________________________)
4) Children of all other categories of eligible Ex-Servicemen.

His identity Card No. is A.P. ___________________________issued on

____________________at Zilla Sainik Welfare Office ______________________He is
resident of _____________village _____________ Post ____________________ Mandal
____________________ District __________________ State.
The certificate is issued for the purpose of availing the benefits to the children/dependents
of Ex-servicemen for admission to first year of the 6 years Integrated Engineering
programme in RGUKT, against the seats reserved for Children of Armed Forces personnel
category.

Date:
Place:
Signature
Name and Designation of the
Officer
Seal of Issuing Authority.
Note:

The Children of Ex-Servicemen are directed to bring the following original certificates at the
time of spot admissions/counselling.

1. Original Discharge Certificate of his/her parent.

2. Original Identity Card of his/her parent issued by Zilla Sainik Welfare Officer or
Concerned district.
3. Original Pension Book of his/her Parent, if pensioner.
4. Residential Certificate of the parent of the Candidate issued by Mandal Revenue
Officer.
5. Certificates of Gallantry Award Gazette Notification, Copies of Part – II Order and
relevant Documents if claims under priority-I, priority-II and priority-III.
6. Children of Armed Forces Personnel Certificates issued by Zilla Sainik Welfare
Officer.

The Children of serving Soldiers are directed to bring the following original Certificates at
the time of spot admissions/Counselling.

1. Original Identity Card of his/her parent issued by competent authority.

2. Original Pay Book/Pay Slips of his/her parent.
3. Residential Certificate of the Parent of the Candidates issued by Mandal Revenue
Officer.
4. Certificates of Gallantry Award, Gazette Notification, Copies of Part-II Order and
other relevant documents if claims under Priority-I, priority-II and priority-III.
5. Children of Armed Forces Personnel Certificates issued by Commanding Officer.

In the event of to produce the above documents in original failure, his/her application
under Children of Armed Forces Personnel (CAP) category will not be considered for
admission into respective courses.

Priorities under Children of Armed Personnel etc., (CAP) Category:

The Priorities under this category are as follows:

Priority No. 1:
Children of Armed personnel, BSF personnel and CRPF personnel killed in action and
of Telangana police personnel killed in extremist violence.

Priority No. 2:
Children of Armed Forces personnel, BSF personnel, CRPF personnel and Telangana
police personnel disabled in action and in extremist violence respectively and
invalidated out from service on medical grounds.
Priority No. 3:
Children of Armed Forces personnel, BSF personnel and CRPF personnel who have
received the Gallantry Awards.

The following Gallantry awarded will be considered in the order of merit.

(a) Armed Forces personnel:

1. Param Vir Chakra

2. Ashoka Chakra
3. Sarvotham Yudha Seva Medal
4. Mahavir Chakra
5. Kirti Chakra
6. Uthama Yudha
7. Vir Chakra
8. Shaurya Chakra
9. Yuddha Seva Medal
10. Sena Medal or Navsena
Medal or Vayu Sena Medal
11. Mention in Dispatches

(b) Gallantry Awards for CRPF/BSF Personnel:

1. President’s Police and Fire Service Medal for Gallantry
2. President’s Police Medal for Gallantry
3. Police Medal for Gallantry.

Priority No. 4:
Children of other Ex-servicemen/Servicemen/BSF personnel and CRPF personnel.
The order of priority and merit is governed by G.O.Ms.No. 192, Edn. (EC-2) Dept.
dated 26-08-93 as amended by G.O.Ms.370, Edn. (EC-2) Dept., dt. 18-10-1994 and
G.O.Ms.No. 55 H.E (EC.2) Dept. dated 08-07-2009.
 ANNEXURE-VIII
Priorities for NCC and Sports and Games

A. National Cadet Corps (NCC) Category: (The Priorities are as per GO.Ms.No. 21 H.E.
(TE-1) DEPT. DT: 13-05-2002.).

Priority – I:
NCC Cadets participating at International Level for Youth Exchange programme. (‘A’
certificate holders)

Priority-II:
NCC Cadets participating at national Level (‘A’ certificate holders) in the following
order of priority:

a) Republic Day camp at New Delhi

b) All India Thal Sainik Camp/Navy Sainik Camp/Vayu Sainik camp for Republic Day
banner competition.
c) National Integration camp at Andaman & Nicobar Islands.
d) Participants of Para Jumps/Skydiving/Mountaineering at national level/medal
winners at National level shooting completion with national Rifle.
Association/Award winners in N.C.C. Games at National level.
Priority–III:
The Priority in descending order will be as follows:
a) Participants at Republic parade at State Level.
b) Participants at Independence Day at State level.
c) ‘A’ certificate holders.
Note:
1) Only the candidates who attained ‘A’ certificate prior to appearing in the
qualifying examination are eligible under N.C.C quota.
2) The N.C.C. Directorate, Telangana /A P shall be responsible to draw a merit list in
respect of N.C.C. Cadets seeking admission under N.C.C. Quota for all categories.
3) In case of tie, tenth class merit will be the deciding factor.
4) Only N.C.C. Certificates issued by N.C.C. authorities shall be valid.

B. Sports and Games: The applicant must have got certificate at the Inter-District or
above level. Selection on the basis of merit in sports/games. In case of tie, tenth
class merit will be the deciding factor. Priorities as per the Government Rules in
force.
Note: Reservations under Sports & Games will be considered as per the provisions of G.OMs.
No. 7, Youth Advancement, Tourism & Culture (Sports) Dept., Dated: 21-06-2018
 ANNEXURE-IX
INCOME & ASSETS CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER
SECTIONS

Certificate No. Date:

VALID FOR THE YEAR

This is to certify that Shri/Smt./Kumari son/daughter/wife

of
permanent resident of ,
Village/Street
Post Office District in the State/Union
Territory
Pin Code whose photograph is attested below
belongs to Economically Weaker Sections, since the gross annual income* of his/her
'family"** is below Rs. 8 lakh (Rupees Eight Lakh only) for the financial year His/her
family does not own or possess any of the following assets*** :
I. 5 acres of agricultural land and above;
II. Residential flat of 1000 sq. ft. and above;
III. Residential plot of 100 sq. yards and above in notified municipalities;
IV. Residential plot of 200 sq. yards and above in areas other than the notified municipalities.

2. Shri/Smt./Kumari belongs to the caste

which is not recognized as a Scheduled Caste, Scheduled Tribe and Other Backward
Classes (Central List)

Signature with seal of Office

Name
Designation

Recent Passport size

attested photograph of
the”applicant

“Note1:. Income covered all sources i.e. salary, agriculture, business, profession, etc.

**Note 2:The term "Family" for this purpose include the person, who seeks benefit of reservation, his/her parents and siblings below the
age of 18 years as also his/her spouse and children below the age of 18 years

***Note 3: The property held by a "Family" in different locations or different places/cities have been clubbed while applying the land or

property holding test to determine EWS status.