Professional Documents
Culture Documents
Check Slip
To be filled by you
5. Pincode No.
Sl.No.
Item
Details
Yes*
No*
No*
Gas/LPG connection
( B8,9 & 10)
Electricity connection
(C14,15 & 16)
Document
Yes*
Yes*
No*
No*
Copy of LPG Gas Bill
No*
Yes*
No*
Connection
Yes*
No*
If Yes Meter
Yes*
No*
Yes*
Yes*
No*
Copy :
No*
Bank Account
(D12 & 13)
Yes*
Branch
Account No.
Sex
M/F
Name
Card No.
Copy
(Y/N)
EID
Copy of Certificate
ST*
OBC*
Yes*
OC*
Yes*
Yes*
No*
Copy of Certificate
No*
No*
Yes*
No*
Copy of Certificate
No*
Yes*
Disability (E)
No*
SADAREM/Certificate No.
Item
10
11
Vehicle (G)
Yes / No
No. of Vehicles
Registration No.
Motor Cycle/Scooter
3 Wheeler/ Auto
Car/Jeep
Air Conditioner
Pattedar Pass Book No.:
Revenue Village :
Yes*
District :
To be filled by Enumerator
No*
Copy
(Y/N)