YSR PENSION KANUKA

GOVERNMENT OF ANDHRA PRADESH

CERTIFICTE OF SINGLE WOMAN

(SEPARATED/UNMARRIED)

This is certify that Smt/Kumari……………………………………………………………………….

W/O (or) D/O ………………………………………………………………………………………………..
D.NO……………….Resident of ………………………………………………….…………Village in
………………………………………………….. Mandal of Guntur District is a ………………….
…………………… (SEPARATED/UNMARRIED) Single woman. She is Divorcee /
Separated from her Husband from last ……………………………….. years and living
……………………………. ( Alone / with children). Her Age is ……………..Years as per
Aadhar ………………………………………………………….And Her Ration card number is
………………………………………………………………………

Applicant signature

Signature of V.R.O. Signature of Tahsildar

with Seal