New Family Registration

District: _______________________________________ Area (Rural/Urban): _________________________________________

Block/Town: ____________________________________ Ward/Village: _____________________________________________

Head of Household Details

Name: __________________Father Name: _____________Mother Name: _______________ Gender (M/F/T): ____ Age: __________

DOB(DD/MM/YYYY)__________ Declared □ Verified □ Mobile No:____________________ Aadhaar No/EID: _________________________________

* Reason of Addition: ________ Address -> House No: _______ Locality/Colony __________________________ Remarks: _____________________

S.No Name Father Name Mother Name Spouse Name Gender DOB DOB Age Relationship with Aadhaar no./EID Mobile No.
(M/F/T) DD/MM/YYYY D - Declared Head of House (12 digits/ 28
V - Verified hold digits)
1
2
3

5
6
7

* Codes for Reason of Addition 01-New Family Created After Marriage 02-Family Migrated 3. Families Splitting 04-Any other (Specify in Remarks)
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Received Parivar Pehchan Patra form duly filled from Sh. /Smt.................................... S/D/O..................................... resident of..............................................
Name............................ Office Name.................................. Mobile No.....................................
PTO
Benefits of having Parivar Pehchan Patra:- The benefits of various schemes can be easily availed by the eligible household by
showing their Parivar Pehchan Patra for example:
1. Pradhan Mantri Awas Yojana (PMAY) Scheme.
2. Medical benefit/facility: - Ayushman Bharat Scheme etc.
3. Issuance of Ration Card/Ration as per Food Security Act.
4. Family Pension.
5. Old Age Pension/Widow Pension/Phy. Handicapped Pension etc.
6. Various Scholarship Scheme:- Post Matric scholarship etc.
7. Issuance of RC/Driving Licence etc.
8. Social Welfare schemes like Ladli, Vivah Shagun Yojana etc.
9. Agriculture/ Horticulture Departments Schemes-Subsidy on various schemes.
10. Helpful in tracking missing member of the family.
11. Helpful in obtaining Govt/. Private Jobs:- Weightage to those families where no family member is in job.
12. Helpful in seeking admission in school/college etc.
13. Any other Scheme for which the resident is eligible.
Name -----------------------------------

(Signature of Head/Representative of Family)

It is certified that the information given above is true and family members have agreed to give this information for
Parivar Pehchan Patra.