FORM R. O.

1
Gevernment of West Bengal

Application for Family Identity Card/Ration Card

(The Enquiry Clerk will assiet you have to fill up the form if you are in doubt over any of the entries.)

Name of applicant......................................................................... Residential address, House No................., Flat No./Floor No................., Street/Road/Lane........................................................
(in block letters)

Name and address of Landlord .......................................................................................................Bariwala (if you live in a Bustee)

Name of the Head of Family (if applicant is not himself the head of family)........................................................................................

Please give the following particulars of the persons for whom Family Indentity Card/Ration Card is required :Name in full of the members of the
family for whom Family Identity
Cards/Ration Cards are required including the same of the applicant if
he/she requires a Family Identiry
Card/Ration Card.

If any Family Identity

Card/Ration Card was issued before, has it been
surrendered if so, to
whom.

Relationship to
the Head of the
family.

Immediately
previous
address.

Age

Name of father/husband (in

case of married women)

N. B. - To obtain or attempt to obtain a Family Identity Card / Ration Card by furnishing false information is to
contravene the provision of clause 12 of the Calcutta Industrial Area Rationing Regulations, 1994, or the Calcutta Industrial
(Extended) Area Rationing Regulations, 1964, as the one may be. Such contravention is an offence undre section 7 of Act 10
of 1955 read with paragraph 17 of the west Rationing Order, 1964, punishable with imprisonment for a term which may extend
to three years, or with fine, or with both.

Occupation Mainly rice or

weat eater.

Date of
arrival.

Period of stay.

A. B. Shop No.
desired.

I solemnly affirm that the above statements are true to my knowledge/behalf/information.

............................................................................................................
F.I.O/R.O. No. (if any)............................ Folio Serial No..............
A.R. No. ......................................................................

R. O. 1 (COUNTERFOIL)
Name of applicant...................................................................................................................................Address.........................................................................................................................................................................................................
LETTER OF AUTHORITY WHEN THE APPICANT CANNOT TAKE DELIVERY IN PERSON
I do hereby authorise ................................................................................................... of ....................................................................................... to receive the relevant Card (s) and sign the receipt therefor my behalf my own risk and
responsibility.
Date .......................................

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Signature of left thumb impression of the applicant

File no................................

Remonable date ..............................

Serial No.........................................
Leader ............................................
REPORT OF THE ENQUIRY OFFICER

Date and time of enquiry ................................................................................... Short desorption and position of the house of the applicant ......................................................................................
Have you met the applicant ? If not, give the name and address of the person from whom enqired of ..................................................................................................................................................
...............................................................................................................................................................................................................................................................................................................
Do you recommend issue to Family Identty Card/Ration Card ? In not, why not ? ...............................................................................................................................................................................
...............................................................................................................................................................................................................................................................................................................
General remarks....................................................................................................................................................................................................................................................................................
(Enquiry should be as through as possible)
Order of the Rationing Officer...............................................................................................................................................................................................................................................................
Serial No. of the Family Identty Card/Ration Card issued, if any..........................................................................................................................................................................................................
RECEIVED ABOVE CARD(S)
..........................................
Initial of Delivery Officer.

..................................................................................................
Signaters or thumb inpression of the applicant of -----R. O. 1 (COUNTERFOIL)
Serial No. ...............................

Filed on ..............................
This counterfoil should be produced is this office on ......................................................................................................................................... when a replay will be given.

Dated ...................................

................................................................
Rationing Officer

WBGP-03/04-1163B-1Lakh
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