Government of West Beng Form-2 Application for change and correction of ration cards [ Vide paragraph 13 of the WBPDS (M&C) ORDER,2013], 1, Shri/Sme a zi of (address) _-. apply forthe following ‘changes and corrections in the Ration Card/Cards of which the particulars are given below = Changes/Corrections applied for (Address : From to 2) Name/Sumame: From to = — GB) Age: From 0 (4) Head of Family : From to Who is a member of my family and stays with me. Reason for changes Particulars of Ration Cards| ‘Name of holder Ration Card No, EPS No. Folio No. sure oF L-T.1 ofthe applicant Counterfoil of Form-2 Received one application from SriSmt. of Address Receipt Sl.No. . : & Date. Returnable Date... Signature of the Receiving Oficial(FOR OFFICE USE ONLY) i Serial No, Report of Enquiry Officer (Order of the Ration Card issuing authority Received the following Ration Cards Signature of the Delivery Official