APPLICATION FOR INCENTIVE OF INTER-CASTE MARRIAGE One Joint

Photograph of
the Couple Duly
Attested

A. Particulars of the Applicant:

1 Name (CAPITAL LETTER) :
2 Fathers Name :
3 Date of Birth :
4 Address :
5 Caste Status : SC General
6 Sub-Caste (in case of SC) :

B. Particulars of the Spouse:

1 Name (CAPITAL LETTER) :
2 Fathers Name :
3 Date of Birth :
4 Address :
5 Caste Status : SC General
6 Sub-Caste (in case of SC) :

C. Marriage:
1 Date of Marriage :
2 Details of Marriage :
Registration Certificate
3 Whether living together :

D. Others:
1 Whether any child is born out :
of this wedlock
2 Whether any such grant has :
been received earlier from any
authority

E. Documents Submitted:
1 Attested copy of Caste Certificate.
2 Attested copy of Marriage Certificate.
3 Attested copy of Proof of Residence.
4 One Joint Photograph of the Couple Duly Attested.

Declaration: We hereby declare that the above information are true to the best of our knowledge and we shall be entirely
responsible for these information. We understand that the grant amount will be forfeited if any of the information is found
incorrect.

Date: Signature of Spouse Signature of Applicant