© Government of Keraia (]dh(1)~
Reg, No, mml.
rrum
m11Jrt}
K UTV(N)!1 212009-201 j
2010
KERALA GAZETTE ~db0g}
v
(J)ffi)OO
EXTRAORDINARY PUBLISHED BY AUTHORITY ~Ul1.a,o(l)1.a,Q)J(\}j] l,.u(IU11W61~Sl = lcm«ii
Vol. LV
}
Thiruvilnanthapuram, Tuesday
an1elrummnnJ6(t)o,
55
6bJogj
10th August 2010
2010
,",",(J)'AlI
19th Sravana
1932
,UOO()JGmo
to 193:1
19
GOVERNMEl'
NOTIFICATION GO. (P) No. 24/2010lTID.
,.'
Dated, Thiruvananthapuram, 4th August, 20 JO,
S. R. O. No. 797/2010.-ln exercise of the powers conferred under section 90 read with sections 6 and 6A of the lnfonnation Technology Act, 2000 (Central Act 21 of 2000), the Government of Kerala hereby makes the following rules, nameJy: L Short title and commencement.-(l) These rules may be called the Kerala Information Technology (Electronic Delivery of Services) Rules, 2010. (2)
They shall come into force at once.
2. Defmitions,-(l) requires,-
In these Rules. unless the context otherwise
PRINTED AND PUBLISHED BY THE 5Ul'ER1NTtiNDEW OF GOVERNMll."IT PRESSES AT THE OOVEJlNMENT CENTRAL pRESS, THJROVA!-IANTHAPURA~1, 1010.
33l3234/2010/DTP.
(a) "Aer' means the lnfunnation Technology,Act, 2000 (Central Act 21 of 2000); (b) "ilUthorized agent" means an agent of the Government or of the serviCe provider and includes an operator of an electronically enabled kiosk or front office who is permitted under these rules to dellver public services to the users with the help of .. computer resource or , any communication device, by following ,the procedure specified under these rules;
(c) "certificate" means a certificate required to be issued by a statutory authority empowered under any Act, Rule, Regulation or Order of the Government to issue a certifi<:ate to confirm the status, right or responsibility of a persoll, natural or artificial, in accordance with any such Act, Rule, Regulation or Order of the Government and includes a Certificate electronic form printed and issued by a service provider with electronic signature on such stationcry as may be'specified by the Government;
in
(d) "departmental access point" means the front office of a Government department, wherever so established and manned by the authorized agent of the Government, through whiCh the citizen can apply for e~services;
(e) "electronic delivery of service" means the delivery of public services in the form of receipt of forms and applications, issue or grant of any license, permit, certificate, sanction or approval and the receipt or payment of money by electrortic meanS or any otber such public service rendered by following the J?focedure specified under these, ruJes; (I) "e-service" means a service as specified in rule 3; (g) "government" means the Government of Kerala; (h) "official gazette" means the official gazette of tbe Government;' (i) "principal office" means and includes any office, authority, hody or agency owned or controlled by the Government or any institution of Local Self Government who, 4eliver any service to the citizens;
(j) "principal office's fee" meanS any duly authorized taxes, charges,
dues or any other moneys due in respect of a service payable by any person to the principal office concerned that are otherwise payable under the relevant law when making an application to the concerned principal office; (k) "repository o f electronically signed electronic records" means collection of all electronically signed electronic records, stored and managed in accordance with these rules; (I) "service charge" means amount payable to the service provider for
electronic delivery of services rendered and does not include the principal office's fee; (m) "service provider" means any electronic delivery of services provider defin¢ und~r sub-section (1) of section 6A of the Act; . (2) Words and expressions used and not defined in these rules but defined in the Act shall have the same meanings assigned to them in the Act. 3. e-Services.-~ (1) lbe e-services which are available under these rules are specified in column (2) of the table below. The principal office or offices providing the service, the form of application and the format of certificate issued shall be as provided in columns (3), (4) and (.5) thereof, respectively:
Sf.
No. (I)
p'rincipal office
e-services
Application
Certificate
(4)
(.5)
VlIlage/Taluk Office
Form IA
Form IC
(2)
(3)
I
Caste Certificate
2
Residence Certificate
do.
do.
Form2C
3
Identification Certificate
do.
do.
Form 3C
4
Relationship. Certificate
do.
do.
Form4C
.5
Nativity Certificate
do.
do.
Form .5C
6
Legal Heir Certificate
do.
do.
Form 6C
7
Solvency Certificate
do.
do.
Form 7C
8
Location Certificate
do.
do.
Form 8C
4
-'-'-'-~'-~'------'-~'-~'-~'-~'----'-~'-
(I)
(2) .-~
..
(3) -~.-~.-~
..- -..-
..
(5)
(4) -~
..
-~-.-~.-~
..-
9
Domicile Certificate
VillagefTaluk Office
Form fA
Form 9C
10
Income Certificate
do.
do.
Form IOC
II
Possession Certificate
do.
do.
Form 12C
12
Community Certificate
do.
do.
Form DC
13
Possession and Nonattachment Certificate
do.
do.
Form 14C
Inter-caste Marriage
do.
do.
Form 15C
14
Certificate
15
Life Certificate
do.
do.
Form 16C
16
Valuation Certificate
do.
do.
Fonn 17C
17
WidowlWidower Certificate
do.
do.
Fonn lac
18
One and the same Certificate
do.
do.
Form 19C
19
ReligioniCaste Conversion Certificate
do.
do.
Form 20C
2D
Deslitut. Certificate
do.
do.
Form 21C
21
Family Membel'Ship Certificate
do.
do.
Form 22C
22
Dependency Certificate
do.
do.
Fonn 23C
do.
do.
Fonn 24C
23
Certificate
(2) Government may notifY additional services as e-services from time to
time. 4. Service provider /0 collect service charge.-(l) The application for an e-service submitted to a service provider shall be accompanied by a service charge of Rs. 20 (Twenty rupees) payable in cash to the service provlder, at the time of making the application. (2) Service charges for allied e-services are the following,
namely:~··-
L Slatus enquiry
Rs. 2 (Rupees Two only)
2. All print-out rejated
Rs. 2 (Rupees Two only) per page
to
e~services
5
3. All scanning of documents related to e-services
Rs. 2 (Rupees 1\\'0 only) per pagel
4. Acknowledgement Receipt
I'il.
(3) This service charge will not include any taxes, fees, charges, dues or other sums of money that are otherwise payable under the relevant law when making an application to the concerned Principal Office.
5. PrincIpal Office"s fee to be collected by service provider.- (1) Principal Office's fee, if any, shall also he collected by the service provider in cash, except for those payments thai are ordinarily required to be made in the form of court fee stamps or treasury chalans. (2) The Principal Office's fee collected by the service provider shall be remitted with the concerned principal office by the service provider in its entirety. Service provider shall have no claim on the principal office's fee.
6. Remittance of servICe charge and principal office s fee qy lbe service provider.-(l) 50% of the service charge collected by the service provider for an e-service, will be shared by the Governme~t. This will exclude the allied e-services mentioned in sub-rule (2) of rule 4. (2) Of the total service charge collected, the share of the Government shall be remitted by the service provider to the treasury on the same day.
7. Presumption with regard to service charge paid to service provider and other conditions of obtaining e-services. -(1) In case of any service charge paid by any person to a service provider in respect of any specified .-service, the print-oul on paper of the electronic acknowledgement generated by the computer resource in Form No. 1RF and signed and sealed by the service provider and provided to such person by the service provider shall, prima fucie, be proof of such payment and it shall be presumed that the dues or claims, for which the acknowledgement .is purportedly issued, have been satisfied to that extent; however, mere payment by itself shall not create any right, title, extension or condoning the delay or limitation, or relaxation in favour of such person to which he is not otherwise entitled. (2)
The service charge once collected shall not be refunded.
(3) Payment of service charges to the service provider by no means creates any rights Of title, temporary or pennanent in nature in favour of the person concerned regarding obtaining the notified c-services. Mere payment docs not necessarily ensure the delivery of services, rather all conditions of delivery of the service must be met fully at the time of making payment to the service provider. "
6<:1
. (4) Additionally, in case any person impersonates, counterfeits, forges or resorts to any illegal means to obtain any of the e-services, he shall be lishle to be prosecuted. The onus of proving otherwise shall solely lie with die person concerned before any authority or court of law. S. System of Electronic Delivery of Service.-(l) For the purpose of electronic delivery of services the Government shall on its own or through a service provider deliver public services through electronically enabled kiosks or any other electronic service delivery mechanism. (2) Any license, permi~ certificate, sanction, payment receipt or approval delivered in accordance with these Rules shall be admissible in any legal or other proceedings, without further proof or production of th.e original, as evidence of any contents of the original or of any facts' stated therein, provide it is verifiable by one or more of the following manner as explained below:
. (a) The license, permit, certificate sanction. payment receipt oc· approval or any other such public service ha. a unique identification number generated by the computer resource which can be used to verif'y its au~enticity and content. y
(b) The license, pennit, certificate, sanction or approval or any oth": such public service has a bar code which can be used to verif'y its authenticity and content.
(c) The license, penn#, certificate, sanction or approval or any other such public service can be verified with the electronic signature of the authority which has issued it. (d) Any other means notified by. the Government.
9. Responsibility of service provider and their authorized agents. (I) The· Government shall notif'y the functions, resppnsibilities and liabilities of
service provider and their authorized agents in respect of the electronic services delivered which may be updated from time to time.
10, Audit of service provider and authorized agents.- (I) The Government shall cause an audit to be conduled of the affairs of the service providers and their authorized agents every year by appointing audit agencies.· (2) Such an audit may cover aspects such as the securily,. confidentiality and the privacy of information, the functionality and performance of any software application used in the electronic delivery of services and the 'accuracy of accounts kept by the service providers and their authorized agents.
7./
(3) It will be incumbent on the service provider and their authorized agents to provide such information and assistance to the audit agencies appointed by the Government to comply with the directions given by the audit agencies and to rectify the defccts and deficiencies pointed out by the audit agencies,
II. Filing of form. application or any other document.·-Any form, application or any other document referred to in clause (a) of sub-section (I) of section 6 of lbe Act may be filed with any office, authority, body, agency or service provider owned or controlled by the Government of Kerala using the software specified by it and such office, authority, agency or service provider shall, while generating such software, take into account the following features of the electronic record, namely:- (a) life time;
(b) preservability; (c) accessibility; (d) readability; (e) comprehensibility in respect of linked infonustion; (I) evidentiary value in terms of authenticity and integrity;
(g) controlled destructibility; and (h) augmentability. 12. Issue or grant of any license, permitJ sanction or approval,~Any license, penuit, sanction or approval referred to in clau"." (b) of sub-section (I) of section 6 of the Act may be issued or granted by using the software specified under rule I L 13. Miscellaneous.-- The Government shall, by appropriate order, from time to time notify the norms on the service levels to be complied with by the principal office and other offieers involved in the process flow.
8
AffIX Court fee Stamp for Rs. 5 FORM
IA
(See rule 3)
COlvtMON APPLICATION FORM FOR OBTAlNING VARIOUS SER\lICES
FROM TALUKIVILLAGE OFFICE
"alure of Certificate applied for .................... " ... "' ..,..,",.,."" ..,.. ,.. ""'..... ,......... ,...... .. ?urpose : eState [J Cenrral To be produced before ......................................... . Language in which the Certificate is required' 0 English 0 MalayaJam
Part I (General Details)
1. Name of person for whom certificate is applied for ...........................................
2, Gender (}.1JF): ....................................... ,.................................... " ......................................... ..
I'~ 3•. Age: ................. 3b. Date of Birth _ _ L _ I ~~[' L~ __J~I
[ -',[ J '
:~D~e~t=al~ls~_ _ _ _-t_~4~.~P~re~s~e~n~t~A~d~d~re~s~s~_+-~5~. Penn,nent -;1-;lo_u_,_e",N:-;-o_._ _ _-'-_ _ _ _ _ _ _ _ _ _-l-_ _ _ _ _ _. _ _
Housel'iame S IreetIPla.e Post Office
c--:P:::i-n-co-d:-e------r---------~-t-~··-..
J
I
--·---···----j
Village Taluk District Name 0 f Local Body of Local Body 0 Grama Panchaya! 0 Municipality:::J Corporation '----'-'---_. ---._--_... 6, Name of Father: .................................. 7. Name of Moth<;r : .......................... ..
8. Marital Status: [J Matried [J Unmatried 0 Widow [J Widower 0 Divorced
9, Name of Spouse : .................................................................... ,..................................... ..
10. Name of Guardian : ........................................................................................................ .
11. No. of years residing at 11le present address: ...........:............................................. .
12. Phone (Res.) Code: .. ,..................Number : .......... 13. Mobile ................. "' ....
14, Email: ............................................ ,................... ,................. ,............................................ .
15. Ration Card No, : .............................. 16. Driving License No. : .......................... ..
17. Election ill Card No. : ............................ 18. Passport No. : .. """"." ........... " ...... ,, ..
19. Unique Identity No. (1,;10), if any ........................................... " ........................... " .....
ITYPe
9
Part I A (To be filled for C.ste/Community Cerli1icate)
20 (a) to 20 (e) to be filled for the community/non creamy layer certificates
(Items 20d to 201 to be filled if caste/religion has been converted) 20a. Religion: ... H.. H.10b. Caste. : ......... 20c. : Category: GeniSCiST/OBC H.. .
2Od. Original Religion: ........ 20e. Original Caste: .H.:H.20f. Original Name :.......... H.
20g. Certificate No... H, .. H.... 10h. Dated........ H10i. Religious Audlority :..... H..H.. H...... .
Part II B (To be filled for Income/Solvency Ccrli1icates) 21. Income Details:
--II;;~~,;;r;'larypncom;rlncom~lnc;;-~;;-I' RenluaAnyJ-
I I 1 jj I H=TI~:d rl --B~·?L':r~~~: , from
p enslQn"
from
Self Spouse
I'
from
olher
of NRl 1 "ncome
'I
_1"-':
TOlal n
+., l' ~=ly;;;~dtH- 1-----1 --:--'-i- -:--", I~~bq__==t=.=t--r i,_L__ ~: l I '
Fathe7-r--- ,
i -- :
I
----+ I Mother':
I
i
I
j:
~
Part II C (To be filled for SolvencylLand ValuationIPosscssionl
Non .ttachmenlfIncomelLocation Certificates)
22. Property Details: -~'---'
~-~--~~--
~
'" Q ."
til
~
:§
"<
.;:: r.:a
s:
.--.---~
_.-
,-'.
'ti
~
"'~"" i;}
~ <:
t:
Ji
J)
"" 0
"
--~-~
I
~ I
~ I
-'>::..
1:
Jl
"
'>::
t:
~
~
-.
~ ,
t
C>
~ .§
"" ~
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:::::. "
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fi
'""
Ji'"
"-l
~~.-~--
--~-.
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~-
..
~
"
~~-
_.
,
--
,
I
LQrand Total in Words
C>
'
.,,'-
'~-
..:
I
·To be filled for Solvency and Land ValuntlOll certificates only
,
10.1 Part II D (£0 be filled for CasWIdentilkationlNativityl ResidenliallDomicile Certilkates)
Enter Place of Birth details as follows:
State
District
Taluk
Village
..i--".~.
23. Applicant
,
24, Father 25. Mother
.-~
Part II E (Th be
~
for Identification and One and the same CertlllCllte)
26. Alias ruune (8) .............................................................:................................................... .
27. Identification Marks: (i) ...........................................................................
d . . . . . . . . . . . . . . . . . ..
(il) ................................................................................................
Part II F (Th be IilIOO for Inter Caste Marriage Certificate)
28a. Date of Mwriage .......................... :............ 28b. Spouse's Religion......................... .. 28c. Spouse's Caste ........................................... ParI II G [To be filled for legal heir/wldow(er) not re-marrled Certificatesl 29. Name and address of deceased/deserted: ...............................................................
30. Employed as: ....................................... 32.
31. Date of demise : ..................................
Death Certificate No.: ...........:............. 33. Place of Death: (Death Certificate may ~ attached)
.................................. .
34. If deserted, how long: .................
35. Details of legal Heirship Claimants:
Sf. No.. Name of person
I i
Gende'.l!elationship
,
Age
I O~CIIPation
Part II II
ero be 6IJed for dependeru:ylrelationsbiplfamily !llembersbip Certificates)
36. Name and address of person with whom related/dependent: ....... ,................ ,.,..,.
............, .............."., ....................................................., .. .... ........................ " .....................,.....
,",
,
37. Details of Relatives/dependents/family members:
Sf. No.
Name ofperson
Gender
!
Relationship
Age
I
I Occupation !
"--_.'
I
.. _--
.
i
38. e-Distriet Registration Number if any : ...,...,.,. .......... .,................ .,............................ .
39. Enclosures with the application : ..................................... .,..................... ,................... .
DECI.ARAI10N
I do hereby certify that the particulars mentioned above are complete and true to the best of my kriowledge and belief. I also agree. that any loss to Government due to the Incomplete Of Incorrect information provided above may be recovered from my movablelimmovable assets. I also agree that the certificate so issued and any benefits accrued in lieu of that stands nullified on proved
misrepresentation.
'
Signature:
Place : Date:
Name of Applicant : Relationship with the person for whom certificate is applied for (relationship to be specified if the abo ve declaration is signed by Parent/Guardian/Authoriz ed Representative)
Instruedons for Iilling the AppJieadon L Please enter the application particulars correctly and completely.
2: The personal details will be stored in the citizen database as part of the e-District project. 3. Filling up of e-District Registration Number is mandatory for all future correspondence. 4. In order to avail services quickly. please ensure that the information given is correct and complete. 5. Filling up of Part-I (General details) is mandatory in all applications.: 6. Fill up only Part-I (General details) for Life Certificate and Destitute Certificate. 7. For additional information, please refur Kemla Infonnation Technology (Electronic Delivery of Service) Rules. 2010. .
12
Village Offieer'. Verlftcadon Report
13 FORM
IC
•
GOVERNMflNf OF KERAlA CASTE CElITIFICATE
Date: .,........,.,...,.,...........,. Number .."'......,..... ,."" ...,......~., .......".................. Certified that the person with the details mentioned below belongs to the SC under: 'The constitution (Scheduled Castes) Order, 1950 'The constitution (Scheduled Tribes) Order, 1950 [as amended by the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976.]
I'ame of Father/Mother House Name, House I'umber P~;t O-filce ~ith ~;~;;...c
r
Village
Taluk District
Date of issue of Certificate Design.aIion of the_'_·s_su_i_n"'g_o_f_fi_ce_r_ _ _ _+ Name of office issued for
_____________
This certificate is issued based on the details given in the application, local enquiry, facts and records produced. I SignatureiDigital sig;;~ture of the : Approving Authority NOTE
L This digitally signed document is legally valid as per the Information Technology (IT) Act, 2000. 2. Authenticity of this document can be verified from http://edistrict.kerala.gov.inj
FORM
2C
(See rule 3)
•
GOVERNMENT OF KERALA RESIDENCE CERIlFlCAlE
Nwnber : ..
m
Date: ................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Certified that the person mentioned below and his/her family ordinarily resides at the address mentioned below of Kerala State: Name ill Person I£l whom Certificate is issued Gender Age Name of FatherlMother Hous~Name, House 'Number _ _ _ _ _+ Post Office with Pincode Panchayat Village Taluk District Date of issue of Certificate Designation of the issuing officer Name 9.f the office Purpose issued for
______--'_____
This certificate is issued based on 'the details given in the application, local enquiry, facts and records produced. .\, SignaturelDigital Signature of the Approving Authority , -~..
I '
Ncm;
I. This digitally signed document is legally valid as per the Information Technology (l1) Act, 2000. 2. Authenticity of this document can be verified from http://edistrictkerala.gov.inI
15.1' FORM 3C (See rule 3)
•
GOVERNMENf OF KERALA
IDENTIF1CATION CERIIFlCAJE
Date : ................................
Number : ......................................................
Certified that the details of the person mentioned below are correct so far as to prove the identity of the person:
-
..
Name of Person to whOOl Certificate is issued Gender Age ....
- -•••- >
_
...
-----~--
.
....
Name _ . of FatherIMother House Name: House Number Post Office with Pincode Marks of identification .... _---------- ... Panchayat Vtllage ..
---
j
-~
Taluk Dlstnct Date of issue of Certificate Desigm.tion of the issuing officer Nllll1e of the office Purpose issued for This certificate is issued based on the details given in the application, local inquiry, filcts and records produced.
Sigilature/Digital Signature of the I Approving Authority
NOTE
1. This digitally signed document is legally va1id as per the J.nliJnnalion Technology (IT) Ac~ 2000. 2. Authenticity of this document can be verified from ht1p:lledistrict.keraIa.gov.inI
16
FORM
4C
(See rule 3)
•
GOVER.~T
OF KERALA
RELATIONSHIP CERTIFICATE Number: ................................ ,...................... .
Date: ................................
E . . ._..
Name of Person to whom. C<;rtificate is issued :
~:~~Name, House Number .........~,~
Post Omce with Pincode Village Taluk District
;;:;-;-7---'-------.....-
....;-----~
Certified that the person mentioned above is related to the person (5) mentioned. below and the nature of relationship is as stated.
Name
Relationship
i
Age
-----"c.=.:.:.-.--,----r---"'.: .....-.-'.~ ....._ -
- - - - - - - - - - - - + - - - - - - - - + -.. -~--
Date of issue of Certificate Designation of the issuing officer Name of office Purpose issued for This certificate is issued based on the details given in the application, local enquiIy. mcts and records produCed. :-.... . . SignaturelDigital Signature of the Approving Authority
NO"J""E 1. This digita1ly signed document is legally valid as per the lnfonnation Technology . Act, 2000. . 2, Authenticity of this document can be verified from http://edistrict. keraia.gov.inJ
(In
17 FORM
5C
(See rule 3)
•
GOVER.'lMENT OF KERALA NATIVITY CERTIFICATE Number:
Date: ..
<.... « .. <..««<...... <....««<........ <........
< .. < ........................ ..
Certified that the person with !he details mentioned below ill a native of Kernl. State..
•
Name of Person to whom Certificate is issued Gender Age Name of FatherlMother House Name, House Post Office with Pincode Village Taluk
District Date of issue of Certificate of the Name of office issued for This certificate is issued based on the details given in the application, local enquiry, facts and records produced.
I Sign.tu~sital Signature of !he I Approving Authority
~
1. Thill digitally signed document is legally valid as per !he Information Technology (II) Ac~
2000.
2. Authenticity of this document can be verified from http://edistnct.kerala.gov.in1
3313234120101DTP<
<
18 FORM 6C (See rule 3)
•
GOVERNMENT OF KERALA LEGAL HEIRSHIP CERTIFICATE Number: ..................................................... . Date: ....................................... Name of Gender
- -... -~....- - - j - - - - - -
..
-~
---
....
Address with Pincode Certified that the person mentioned below are legal heirs of the deceased mentioned above and the nature of relationship is as stated.
Name
Age
This certificate is issued ba~d on the details given in the application, local enquiry, facts and records produced and notification published in the Kerala G=tte No. xxxxxxx, Volume xxx dated xxxxxx.
~
i~naturefDigit.1
Signatu;e of Approving Authority
..
~-
j
..- - - - -..
NOTE 1. This digitally signed document is legally valid as per !be Infonnation Technology (IT) Act, 2!XXl. 2. Authenticity of this document can be verified from http://edistrictkerala,gov.inJ
19 FORM 7C (See rule 3)
•
GOVERNMENT OF KERALA SOLVENCY CERTIFICATE Number: ............................................ . Dale: ....................................... Certified that the person witb the details mentioned below is solvent to tbe extent of Rs. """""" (in words··»
Name of Person to wbom Certificate is issued Gender
'-+1-
T------
---. ----. ------- +
Age------·
:::~:::;~:fu:~::-------~-l+-· ~ost_.9ffice with PilK:od-,,_~_' _______ Panchayat __ '
v~
______
___________._________+----------_____--.
Taluk
-.-.---------------1-------.--.
District
.---~
--~--~-----
Date of issue of Certificate
---
..
----------
Designation..of the issuing offic"-'--. ___.._"-_-'-_ _ __
Name of_0.cffi=l:.:C-ce,-:-________ Purpose issued for
..._.~'___.__.__.,,_ _.__._
----------------~~~-----.-------
This certificate is issued based on tbe details given in the application, local enquiry, facts and records produced. .
SignalUre/Digital Signature of !be
1l.....-..._Approving Authority _.•._ _ _.__.
J
NOTE
I. This digitally signed document is legaUy valid as per !be lnfurntation Technology (IT) Ac~ 2000. 2. Authenticity of this document can be verified from hlIp:lledistricl.kerala.gov.inI
20 FORM 8C (See rule 3)
•
GOVERNMENT OF KERALA LOCATION CERJ1FICATE Number : ........................................ Date : ................................
Certified !bat !he property wilh !he particulars mentioned below is located as detailed:
Name of PetliOn to whom Certificate is issued . Gender Age Name of FatherlMother House Name, House Number POIIt Office with Pincode Panchayat Village Taluk DIStrict Old Survey/Sub Division Number Re-Survey Block Re-Survey RumberlSub \)ivlJ!lon Number Descri2tion oflocation Pro~rty Boundaries: .
0'
South
North
I
West
Date of issue of Certificate Designation of the issuing officer Purpose issued for _ This certificalll is iuued based on the detail. given in the application, local enquiry, facts and 'records produced. SignarurelDigitsl Signature of !he Approving Authority Nom I. This digjtally signed docw:n«u is legally vaIidss per !he mIDrmation TecImoIogy (IT) Act, 2000.
2. Authenticity of this document can be verified from http://ediatricl.kerala.gov.inI
21 FOi!M9C (See rule 3)
•
GOVERNMENT OF KERALA
DOMICILE CERTIFlCA:rE Number ; .............................................,........
Date : ......................_.......
Certified that the person with iIle detaiIlI mentioned below is a domicile of the
-
State of Kerala.
.
Name of Person to whom Certificate is issued Gender Age Name of FatherlMother House Name, House Number. Post Office with Pincode ' ~---
..
Panchayat
Village Taluk ~--
..
~~"-
..
District Date of issue of Certificate
•
Designation of the issuing officer Name of office
Purpose issued for
This certificate is issued based on the details given in the application, local enquiry, facts and records produced.
SignaturelDigitai Signature of the
Approving Authority
1. This digitally signed document, is legally va!id as per the Information Tecbooklgy (IT) Act, 2000. 2. Authenticity of this document can be verified from http://edistrict.kerala.gov.inI
22 FORM IOC (See rule 3)
•
GOVERNMENT OF KERALA INCOME CERTIFICATE
Date: ................................
Number: ................................................ .
Cenified that the Annual Family Income of the person with the details mentioned below from aU source is INR xxxxxxxx (in words"').
Name of Person to whom Certificate is issued Gender Age Name of FatherlMotber House Name, House Number Post Office with Pincode Panchayat Village
Taluk District Date of issue of Certificate Designation of the issuing officer Name of the office Purpose issued for This certificate i. issued based on the demils given in the' applicatipn, local enquiry, facts and records produced.
SignaturelDigital Signature of the
Approving Authority
Nom 1. This digitally signed document is legally valid as per the Information Technology (IT) Act, 2000. 2. Authenticity of this document can be verified from .bt1p:lledistrictkerala.gov.inI
23 FORM 12C (See rule 3)
•
GOVE~"IMENT OF KERALA POSSESSION CERTIFICATE
Date: ............................... .
Number: ............................................ . Name of Pers.on to whom Certificate is issued Gender N~eofFafuer~:~o~ili~er~~____________ House Name, House Number Post Office wi!h Pincode
r-_____________________
1 .1---------
",D",isO;!tn",'c",t_ _ _ _ _ _ _ _ _- - ....
Certified that land shown in the schedule below are in possession and enjoyment of the person wbose details are stated above
-.
Taluk/
i
Village :
Old Survey Re-Survey Re-Survey i Extend 10 Thad.pper Class 0 f Number: Lmd. Ntunber Land Number . Block
i
:
Date of issue of Certificate Designation of fue issuing officer N~e
of !he office
Purpose issued for ..
~
...
-
This certificate is issued based on fue details given in fue application, local enquiry, facts and records produced. Sign,;b.tr.:migital Signature of the I Approving Authority !
NOTE I. This digitaDy signed document IS legally valid as per the Information Technology (IT) Act, 2000. 2. Au!henticity of lhis document can be verified from bttp:lledistrict.kerala.gov.inJ
24
rOllM BC
(See rule 3)
•
GOVERNMENT OF KERALA
coMMUkrrv
CEImFICATE
Number: .......................................................
nate: ................................
Certified that the person with the details mentioned be'low belongs to the community mentioned below: Name of person to whom Certificate is issued Gender Age Namc of FatherIMother .
House Name, House Number
I
Post Office with Piucode
'
Panchayat
I'
~~-----------+,.---------Village
TaJuk District ConununityfCaste -~"
_
..
Religion ..
nate of issue of Certificate
.
Designation of the issuiug officer --~
..
Name of the office Purpose issued for· This certificate is issued based on the details given iu the application, local enquiry, facts and records produced. Signature/Digital Signature of the
Approving Authority
Nom 1. This digitally signed document isJega1ly valid as per the Information Technology (IT) Act, 2000. 2. Authenticity of this· document can be verified from http://edislrict.kerala.gov.W
25 FORM 14C (See rule 3)
POSS~N
•
GOVERNMENT OF KERALA AND NON ATTACHMENT CERI1F1CATE
Number: .......................................
Date: ................................
Name of pmon to whom Certificate i~ issued Name of FatherlMother Address Post Office with Pin code I Distri,,·c. t._ _ _ _ _ _ _ _ _ _ _ _ _-''--'_ _ _ _ _ _ _ _ _ __ Certified that land shown in the schedule below are in the possession and enjoyment of the person as delailed above and it is not .having any other attachments. Taluk/ ! Old Survey J«>.Survey Village i Number Block
Re-Survey Number
Extend to Thandapper Class of Land Number Land ..
_
i
Date of issue of Certificate Designation of the issuing officer Name of the office Purpose issued' fOf _ _ _ _-:-_ _' -_ _ _ _ _ _ _ _ _ _ _ __ This certificate is issued based on the details given in the application, local enquiry, facts and reco~ds produced,
I
isignalUre/Digital Signature of the Approving Authorio/ :
I.
I. This digiIally signed document is legally valid as per the lnfurmation Technology (IT) Act, 2000. 2. Authenticity of this docwneill can by verified fromhitp:lledistrjclkerala,gov,inJ
26 FORM 15C
•
GOVERNMENT OF KERALA INTER CASTE MARRIAGE CERllFICATE Number: ............................................... . Date: ................................ Certified that the person with the particulars mentioned below is inter caste 'married:
Nf-"-"--hO"""-·fi"--""· ame 0 person to w m Cert! cate IS 'ssu.,.j"-'''''---''-''''-'''''''''' I
Gender I
Age
.
Name of FatherIMother House Name, House Number POSI Office with Pin code Pancbayal
Village
.
Taluk D,slnct Dale of
.
Name of WitelHusband n -" of WifelHusband . Caste of WifelHusband Date of issue of Certificate -----.-:2::::.::--::C"---~'--i,-----...~.~-..~---.Designation of the issuing officer Name of the office
Purpo--~ei;r whl-;;h-U;;Certmcaie-igissued for~t-------.. -·--·----~·- ..
_ _ ~, _ _ _ ~~~._~ _ _ _ _ ~~~ _ _ _ _ _ ~ •• _ _ _ _ ~ _ _ _ _ ~.o~ _ _ _ _ _
~_~.,_~~_. _
_ _ _ _. .
This certificate is issued based on the details given in the application, local enquiry, facts and records prnduced.
N
27 FORM 16C '(See rule 3)
•
GOVERNMENT OF KERALA LIFE CERIIFICATE Number: ............. ,................................
Date: ............................... .
Certified that the person with the particulars mentioned below is alive:
I
.~~~
, Name of pc;rson to whom 'Certificate is issued Gender ' Age . Name of FatherlMother House Name, House Number Post Office with Pin code Panchayat Village Taluk District _....
-- ....
....
__
. ----~.
..
Date of issue of Certificate Designati"n of the issuin!! officer , Name of the office Purpose for which the Certifn:ate is issued for
This certificate is issued based On the details given in the application, local enquiry, facts and records produced. SignaturelDigital Signature of the
Approving Authority
NaTE I. This digitally signed document is legally valid as per the IIiformalion Technology (IT) Act, 2000, 2. Authenticity of this document can be verified from ht1p://edistrictkeraia,gov.inI
28 FORM 17C (See iule 3)
•
GOVERNMENf OF KERALA VALUAllON CERJ'IFIC.ATE Number: .............................................. . Date: ................................ Certified 1hat the valuation of the property is as under.
This certificate is issued based on the details given in the application, local enquiry, facts and records produced.
rsigna~reioigital Signa~-;;f thje
IL -__________________ Approving Authority NOTE
1. This digitally signed document is legally valid as per the lnfonnation Technology (IT) Act, 2000. 2. Authenticity of this document can be verified from http://edistrict,kerala.gov.inI
29 FORM IRC (See rule 3)
GOVERNMENT OF KERAlA WIDOW/WIDOWER CERTIF1CATE Number: ............................................. .
Date: ................................
Certified that the person with the details mentioned below is a widow! widower. Name of person to
wbOm Certificate is issued·
Age
Name of FatherlMother House Name House Number Post Office with Pincode Panchayat
Village Talnk District ~ame of Wife/Husband Dall! of Demise Date of issue of Certificate Designation of the issuing'officer Name of the office
l'tirpose isaued for This certificate i. isaued based on the details given in the awlication, local enquiry, facts aod records produced. Signature/Digital Signature of the .Approving Authority •
NOTE I. This digitally signed dOOlllllellt is Jegally valid as per the infurmation Techaology (IT) Act, 2000. 2. Authenticity of this docwnent can be verified from hnp:!ledistrictiera\a.gov.inI
30 Foon 19C (See rule 3)
GOVERNMENT OF KERALA ONE AND 1HE SAME CERfIFICATE
Date: ................................
Nwnber : ...............................................
Certified that the particu!ats of the person mentioned below is cOlTect.
This certificate is issued based on the details given in tbe application, local . enquiry, facts and records produced.
E
---------·~·--l
SignaturelDigital Signature of thel
.
NOTE:
Approving Authority ~ ,
--
I
-!
/
1. This digitally signed dccwnent is legally valid as per tbe lnfonnation Technology (IT) Act, 2000. 2. Authenticity of lhis docwnenl can be verified from http://edistrict.kerala.gov.inI
31 FORM 20C (See rule 3)
GOVERNMENT OF KERALA REUGIONICASTE CONVERSION CERTIFICATE Number: ................................................ . Date: ................................ Certified thai the new caste and new religion of the person with the particulars mentioned below is as detailed below:
Name:~f~; to whom Certificate is' issu~4-I_ _._ _ _ _ _ _~_ __ Gender .~
Age Nameof FatherlMother House Name,-House Number Post Office with Pincode Panchayat •
.._ _ _ _ _ _ _ _ M _ _
..
._
•
Village
-
Taluk PrevIOUS Caste - - . - - - - - - - . - -.. .. Previous Religion _ _ _ _ _ _ _ _ _ _-L_ _ _ _ _ _ _ _ _ _--;_ Current Laste -~--
Current Religion ."----- D_ate_or..j~s_u_e_of:..C~erti:::·~fi::c~at::e~ _ _ _ _ _ _-!-____________ Designation of the issuing officer ..-------..- Name of the office _ _ _ _ _..____ .. -\1__________ Purpose for which the Certifi_,c_a_te_is issued for.~._~__ ~-----------.---
This certificate is issued based on the details given in the application, local enquiry, facts and records produced. SignaturelDigital Signature of the Approving Authority Nan;
I. This digitally signed document is l~g.lly valid as per the Infum:tation Technology (IT) Act, 2000. 2. Authenticity of this document can be verified from http://edistrict.keraIa.gov.inI
32 FoltM 21C (See rule 3)
•
GOVERNMENT OF KERALA
DESITIUI'E CERl1FICATE Dare: ................................
Number : .........."................".."..."".....
Certified that the penlOIl with the particulars mentioned below is .. destitute:
Name of person to who;c;;;:tifi~ate is issued I Gender,,--~ Age Name of FathrrlMother
House Name, House
Num~b:...:er ........_
Post Office with Pin~=code=~_ __ Panchayat
---------
-+----------- ---+--------~---
__ ~_
Vtllage
I
~ct
I
Date of issue of Certificate
I'
r Designation of the iss!'ing Offic: _ .._" .~ .... l - - - - - . - . - - - _"__." Name of the office --i"---~--':""'-Purpo""i""lIed for___ .1--_ _ This certificate is issued based on the details given in the application, local enquiry, facts and records produced.
I
Signaiureloigital Signature of the Approving Authority
Nom
1. This digitally signed document is legally valid as per the Information Technology (IT) Act, 2000. 2. Authenticity of this document can be ven1'ied from http://edistrict.kernla.gov.inI
33
Fom 22C
•
GOVERNMENT OF KERALA
FAMn:.y MEMBERSHIP CERI1FICATE
Number: ......................... ".."...... "...... ". Name of person to whom CortificateiS"issued
Date : .."".... " .................. ..
Gender
Name of F ather/Mother
Addre...----··········"'''''''---------+· ~-------
Post Office with Pincode . Panchayo!
village:='------------ 1
Tal~
----rl~----------------
District Certified that the person mentioned above is related to the family members as stated below: .
Name
. . '---+-1
Date of issue of Certificate Designation of the issuing officer Name of the office - " ' - - - - - + - Pu~ issued'for
---+--------------
This certificate is' issued based On the details given in the application, local enquiry, facts and reCords produced. . SiplUre/Digital SiplUte of the Approving Authority
. NOTE 1. This digitally signed document is legally valid as per the Infonnatioo 1'ecIInolosY (IT) Act, 2000. . 2. Authenticity of this document can be verified from http://edistrict.kerala.gov.inJ
34 FORM 23C (See rule 3)
• Number: .............................................. . Name of person to whom Certificate is issued Gender
I
Date:................................ .
I.
Aie----------~------il------~---
I
Name of Father/MQther ..........
House Name, HOI.I8e Number Post Office with Pincode
Panchayat
..
--+.__________~_
r:::
I
District
Certified that the person mentioned above is a dependent of the person] persons mentioned below and the nature of relationship is as shown:
_ _ _ Name
I
I
Address
RelatiCl_n_-+I_.__A_g_e_ ---------
DateofmrueofCertifica~
Designation of the issuing officer Name of the offiCe . Purpose issued for
Th. certificate is issued based on the detail. given in the application, local . enquiry, facts and records produced. I
i
SignaiUremigital Signature of the Approving Authority
NOTE
1. 1bis digitally signed document is legally valid a8 per the Information Technology (IT) Act, 2000. 2, ~ticity of this document can be verified from ht!p:lledistrict.l
•
35 24C (See rule 3) FORM
•
GOVERNMENT OF KERALA ~
CERl1FICATE
Date: ................................
Number: .............................................
Certified that the per!IOn mentioned below has not n,..married: Name 'of person
0;.
b:)
..
whom Certificate is issued,
. Age_.. _ _ ~.. _ _ _ _ _ _ _ _ _-+__________~ Name of FatberlMother . - ; - Hause Name, House Number
--
Poot Office with Pincode ..~~.. ..- -..- - - - - ' Pallcbayat . . ~-
--..
'-'-"--"
~~---------~
---1-
~------
-~
t---~---~
..-
. ---
. - -...- - - - - - - - - - - r - - - - - - - - District
-N-a!n~-.o-;:-f;;:W7:ifutHusban-d-;---
-+----_._- ---+
--
State wbether Wife/Husba.nd is deadldesert divorced.
.
NoOry~~~~~rcedld~c--+1- ' - . . - - - - - - Date of issue ofCertifieate Designation "of the issuing officer _ .
:~:~:ff~:
I
___ -=-=:3:_-.-..•-.-.~-.: __
1ltis certificate i. issued blllled on the details given in the application, local enquiry, facls and records produced. IsignaturelDigitai Signatu.re of !be I. Approving Authority. Nom:
1. This digitaUy signed docwnent is legally valid as per the Infonnation Tecbnology (IT) Act, 2000. 2. Authenticity of this document can be verified from http://edislriCt.k:erala.gov.inI
36 FORM IRF (See rule 7)
ACKNOWLEOOEMENTIRECEIPT GOVERNMENT OF KERALA < Title of Akshaya/d"l't office ,. (l""ation of Akshaya/Offiee)
Date: Receipt No. Name: DepOrtment/Office: Purpose: Description of the transaction I Description of the transaction 2 Registration No.: . Application No.: Tentative date of deliv of service Received the payment with thanks Amount in words: ................................................................. Rs.
Amount
Signanrre and Seal of the service provider
Note: Date: Date of Submission of application Name: Name of APPlicant Department/Office: The name of department/Office to which the application is forwarded Purpose: Nanrre of service applied for. The fee if any txJ Government and service charges if any to Aksbaya will be shown in bracket. The total amount will be shown in the right side column. Please quote the application number for all funrre puIpO
OR, NAY KUMAR, Principal Secretary to Government. ExpIan81Dl'y NOlI!
(This does not form part of the notification, but is intended to indicate its general purport.) , Section 90 read with section 6 and 6A of the Information Technology Act, 2000 (Central Act No. 21 of 2(00) empowers the Government txJ prescribe the electronic form in which filing. issue, grant, receq,t or payment shall be effected The Government have decided to make rules accordingly. The notification is intended to' achieve the above Object.
