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PROFORMA REGARDING DOMICILE

C ERTIFICATE 1. Name of the applicant________________________________________________________________ 2. Parentage 3. Residence 4. Date of Birth ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

5. Whether permanent resident of J&K State.(Requisite certificate to be attached) _________________________________________________________________________________ 6. Whether permanent/temporary ration holder of the state. Copy of Ration Ticket to be attached. _________________________________________________________________________________ 7. Whether the applicant/father of applicant has cast his vote during the year (Copy of voter list to be attached)______________________________________________________ 8. Certificate duly attested by the Gazettted officer of the state to the effect that the applicant and his father and fore-father are continuously residing in the state w.e.f. January, 1980 to December, 1989, to be attached. 9. Undertaking from the applicant as mentioned at column no 8 above _________________________ 10. Have you migrated outside the State / Regular balance of birth, if Yes, Give particulars/date wise residence.___________________________________________________ 1. Purpose for which requisite certificate required.__________________________________________ Signature of the Applicant Declaration Certificate

I_____________________________________S/D/W____________________________________ R/o____________________________________________________________________________ have read and filled up all the requisite item from No. 1 to 11 personally. All these entries are true and correct to the best of my knowledge and belief. Nothing has been concealed thereof, if any entry proves to be false, I shall be liable to prosecuted under law. Signature of the Applicant

OFFICE OF THE TEHSILDAR _______________ No ______________________ Dated__________________________

As verified by the Naib Tehsildar _________________________Circle________________________ vide his No.________________________Dated._________________________ and documents enclosed by the applicant, the entries shown above are genuine. However, the documents shown at S.No._________________ could not be produced by the applicant.

Certified that___________________________________S/o,D/o,W/o_______________________________ R/o__________________________________________________________________________________ _ has been continuously residing at_________________________________ w.e.f. 01.01.1980 to Dec. 1989. His Date of Birth is__________________________ (Copy Enclosed) It is requested that the requisite certificate may kindly be considered under rules. Tehsildar _______

Subject: -

Issuance of domicile certificate.

1. Name ______________________________ S/o _____________________________________ R/o ________________________________________________________________________ has applied for domicile certificate relaxation in pursuance of Govt. order No.1068 (GAD) of 1995 dated 11-12-1995.The case has been verified by the Tehsildar __________________who has recommended vide his No_____________________ dated _____________________ for issuance of requisite certificate in favour of the applicant.

2. The applicant has produced the following evidence in support of his claim. a) State subject certificate; b) Voter list; c) Non-migration certificate issued by the Gazetted officer; d) Date of Birth certificate/ Matriculation Examination Marks sheet; e) Ration card; f) An affidavit; g) Report of S.H.O concerned; h) Other documentary evidence in support of his/her claims. 3. In view of the above mentioned facts there seems to be no objection, if the requisite certificate is issued in favour of the applicant under rules.

OFFICE OF THE DEPUTY COMMISSIONER ______________

CERTIFICATE NO.___________/SQ/DMS OF 20__ Dated:-_______________

As per the report submitted by the Tehsildar,___________________vide No.______________ Dated___________________ in pursuance to the provisions of Government Order no. 1068 GAD of 1995 dated 11-12-1995 issued vide General Administrative Department No. GAD (MTG) RB/81-83 dated: 11-12-1995, it is hereby certified that

Sh./Smt._____________________________________________________________________ S/o,D/o______________________________________________________________________ R/o_________________________________________________________________________ Aged about_________________________ years, Tehsil______________________________ District ______________________ has been continuously residing in this District w.e.f. January, 1980 to December, 1989.

No. Dated:-

District Magistrate,

Copy to the Sh/Smt____________________________________________________________applicant for information. This is in reference to his/her application.

Dated: ______________________

OFFICE OF THE DEPUTY COMMISSIONER ______________

CERTIFICATE NO.___________/SQ/DMS OF 20__ Dated:-_______________

As per the report submitted by the Tehsildar,___________________vide No.______________ Dated___________________ in pursuance to the provisions of Government Order no. 1068 GAD of 1995 dated 11-12-1995 issued vide General Administrative Department No. GAD (MTG) RB/81-83 dated: 11-12-1995, it is hereby certified that

Sh./Smt._____________________________________________________________________ S/o,D/o______________________________________________________________________ R/o_________________________________________________________________________ Aged about________________________ years, Tehsil_______________________________ District ______________________ has been continuously residing in this District w.e.f. January, 1980 to December, 1989.

No. Dated:-

District Magistrate,

Copy to the Sh/Smt____________________________________________________________applicant for information. This is in reference to his/her application.

Dated: ______________________

GOVERNMENT OF JAMMU AND KASHMIR OFFICE OF THE DEPUTY COMMISSIONER _____________

CERTIFICATE NO.___________/SQ/DMS OF 20__ Dated:-_______________

As per the report submitted by the Tehsildar __________________________________________ vide no. ____________________________________________dated _________________________ pursuance to the provisions of Govt. order no 1068GAD of 1995 dated 11-12-1995 issued vide General Administration department no. GAD(MTG)RB/81-83 dated: 11-12-1995, it is hereby certified that Sh/Smt______________________________________D/o,W/o,S/o____________________________ R/o_______________________________________________________________________________ Aged about____________________years, Tehsil________________________________________ District ____________________________have been continuously residing in this District w.e.f. 1980 to December 1989.

No: Dated:

District Magistrtate

Copy to the:Sh/Smt__________________________________________________________________Applicant for information. This is in reference to his/her application.

Dated:-___________

AFFIDAVIT

I _________________________________________________________________________________ S/o _______________________________________________________________________________ R/o _______________________________________________________________________________ do hereby declare on ought as under. 1. 2. That I am a permanent resident of J&K State, District _________________________________ That I or my parents have not migrated from District ________________________________or the valley W.e.f 1-1-1980 to 31-12-1989 and have been continuously residing in District ___________________________________ 3. That the affidavit is submitted in favour of Tehsil office ______________________________ for issuance of Domicile certificate.

Deponent

Verified that the contents of the affidavit are true and correct.

Deponent

Information

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