FORM OF APPLICATION FOR OBTAINING SCHEDULE TRIBE CERTIFICATE FROM THE DEPUTY     COMMISSIONER  PAPUM PARE DISTRICT 

                                                                        ARUNACHAL  PRADESH

1. Name in full (In block letter)  ...................................................................

2. Father name ............................................................................................         

                                (i)  Father name  ...........................................                                                                  

(ii) Whether father is an APST or Not APST ................................... Non - APST ...........................

1. Name of Mother    ....................................................................................                                                                  (i) Name Tribe of Mother           ..................................................................                                                            (ii) Whether Mother is APST or Not APST .......................................

2. Permanent address of the applicant

                                                Village   ..........................................................

                                                Circle     ...........................................................

                                                 Sub-Divn .........................................................

                                                 District      ........................................................

5.  Name of Tribe                                 ..............................................................

6.  Date and year since when residing in Papum Pare District. ...............................................

Place :- ....................................................

   In case the applicant is minor, applicant is to be signed by/Parents/Guardian (if parents no alive).

VERIFICATION

    Certified that both the parents of Shri/Smti ................................................. are bonafide APST Tribe ..................................................................... and thereby said applicants a bonafide. (Mention the tribe) Schedule Tribe of Village ............................................... Circle.......................................... District .................................................

            I have verified the above particulars and found correct.

CO/EAC