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  GOVERNMENT OF KARNATAKA
 Certificate Printing(Reprint)
REVENUE DEPARTMENT
  
FORM-F
Ack No: RD0038048116631 Search Office of Tahsildar,
Athni   Taluk,
Date: 11/09/2019
  FacilityName Ack. No ApplicantName FatherName Document Type
INCOME AND CASTE CERTIFICATE
Caste and Income Certficate RD0038048116631 SHIVARAJ PUJARI SIDDAPPA C
Certificate
View the Draft Copy. If it No:
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RD0038048116631 *RD0038048116631*
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This is to certify that     Kumar.   SHIVARAJ PUJARI     S/O   Sri.   SIDDAPPA(Father Name)   and
Draft View Pay Service Fee
 Smt.   GIRIJABAI   (Mother Name) residing at Shivanur , Athani , BELAGAVI , 591232  of  Shivanur
( Shivanur )   Village/Ward,   Ananthpur  Hobli,  Athni   Taluk,  Belagavi  District  and his/her family
does not come within the purview of creamy layer specified in Government Order No.:Himvaka 304
BCA 2017; Dt: 14.09.2018.
Either the applicant or his/her/parents/guardian/wife/husband is not class-I or class-II officer in the
service of the Government;
OR
Does not hold an equivalent post in Public Sector Undertaking;
OR
Is not an employee under a Private Employer and drawing a salary which is not less than that of a
Class-II Officer (initial stage of the pay scale of Rs.22800-43200/-)
OR

His/Her Father, Mother/Guardians Gross Annual Income does not exceed Rs.8.00 lakhs (Rs. Eight
Lakhs)
OR

His/her parents/Guardian/husband/wife is not holding 10 units of Agricultural land or such of those

not holding more than 20 acres of plantation land as specified in the Karnataka Land Reforms Act
1961.

Certified that       Kumar.   SHIVARAJ PUJARI       S/O    Sri.   SIDDAPPA residing at Shivanur , Athani
, BELAGAVI , 591232  of  Shivanur ( Shivanur )   Village/Ward,   Ananthpur  Hobli,  Athni   Taluk, 
Belagavi  District  belongs to caste    Kurab     of    Category I I (A)     of the Backward Classes and
certified that his/her family annual income is Rs. 16000 /- (  Rs. sixteen thousand only. ). 
This certificate is valid for five year.
Date:11/09/2019
Note : This is a digitally signed certificate and does not require manual signature.
BARCODE
Please, verify authenticity of this certificate by visiting
www.nadakacheri.karnataka.gov.in & entering certificate Number or by SMSing KA
NK <certificate Number> to 161.
Name: REJESH BURLI
Tahsildar
Athni  Taluk
Belagavi District

This Certificate can be Verified at

Ver: 4.1     
www.nadakacheri.karnataka.gov.in .