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Issue of New Ration Card (Pink) Application Form
Issue of New Ration Card (Pink) Application Form
Professional Details
Occupation*: _________________________________________________________________________
_______________________________________________________________
______________________________________________________
Annual Income*: _______________________________________
_______________________________________________________________________________
________________________________________
Consumer No*:__________________________________
__________________________________
Residence Address
Door No *:: _______________________ Locality / Land Mark*:: ____________________________________
State*:: ________________________________ District*:: _______________________________
Mandal*: _______________________Village / Ward *: ______________Pin Code:______________
FP Shop No*: ______________________________
Permanent Address
Door No *:: _______________________ Locality / Land Mark*:: ____________________________________
State*: ________________________________ District*:: _______________________________
Mandal*:: _______________________Village / Ward *: ______________Pin Code:______________
Add Member Details: YES NO
If Yes, Please Enter Member Details
Member Gend DOB Mother Father Spouse Opting to Age EID UID Relationship
Name er (DD/MM Name Name Name Lift with Head
/YYYY) Commodity of the
(True/False) Family
Other Details
Old Ration Card No. (If any): _________________________________
______________________________________________________________
_______________________________
Informant Details
Informant Name*: ____________________
__________________________________ Informant Relation*: _________________________
Delivery Type*: _______________________________ Mobile No*: ______________________________________
________________________
Proof Document*: _______________________________________
Applicant’s Signature