RATION CARD

@[ _u / [ u / [ [0 @0g lML u
APPLICATION FORM FOR CHANGE OF ADDRESS / NAME DELETION INCLUSION &OTHER CHANGE
L M :
Card No:
For Office Use Only
@ _ M :
Shop Code No :
SCI (Zone) SCO (Zone) / SCO (Dist) SCI (Dist) SCO(State)
Change of Address
LQ[ :
From:





(@_u Ll0 @u LL lu) (Latest
Address appearing in family card should mentioned):

[ :
l [
....@..,


To:
Assistant Commissioner,
Civil Supplies and Consumer Protection Department,
.
/ Sir ,
@u: @[ _u / [ u / [ [0 _0u
Sub : Change of Address / Name Deletion / Name inclusion / Other Changes
******
@_u Ll0 lG@u _0u / @0u Q @G
I request you to make the following changes / correction in my Family Card

@[ _u / Change Of Address:
@[ / Old Address :

@u M @[ / New Address to noted:







Q @Ll_ u / Address Proof for New
Residence :
[ 0 / Deletion of Name :
[ u M [/ / Q@
Name of the person to be deleted / Age / Relationship:

1.

2.

3.

4.

[ u _ u /
Reason for deleting the Name:
[ [0 / Inclusion Of Name :
[L_u [G [ / / Q@ / Name , Age
, Relationship of Persons to be included :

1.

2.

3.

4.

[L_ u([ 0 G/lLQ G) :
Proof for Inclusion ( Name Deletion Certificate / Birth Certificate ) :
_0u [ @u / [ @u:
Other Changes / Name / Age / LPG Cylinder Correction :





@_@ LL lu:
Supporting Documents enclosed for Correction: