Public Works Department

Application for Pensioner’s ID Card

Paste a photo Paste a photo
graph (Attested graph(Do not
pby Controlling Sign on this)
Officer)

Name of the Applicant :

Office in which worked last :

PEN at the time of Retirement / PWD ID Card :

No
Designation at the time of retirement :

Present Address :

Date of Birth :
Date of Retirement :
Voters ID Card Number :
UID No(Aaadhar No) :
Mobile No/Contact Phone No. :
Blood Group :
Signature of the applicant (It should be in the :
box provided and legible for scanning)

Signature of the applicant

Certified that the above information is correct and the applicant has been retired from the
mentioned office on ……………………………………(date) .

Signature of Head of Office(At the time of retirement)

1.Department ID card should be surrendered at the time of application

2.Photo copies ( attested by the Head of Office) of Relieving Order, Election ID Card, Adhar
card should be submitted along with this application