(PSD - ath HWarpoctba S0GH55 Hevibs0 AM YSR Pension Kanuka Field Verification Form secretariat ame~Kalekhanpeks ____seeneramiar cope—lOFO023 Name Of the Applicant--- Aruna kroner. _. aadhaar Number-441)-1828_S836 Name of the Father/husband-- ©! -Gragrallen Rao cast--0S- sub Sem Rice Card Number 23123893. __ income Certificate No-RUUC-22114 102063 — _ Gender- -—— mobite Number--J24322 2299S. abitation MTN... Type Of the Pension — bliss Age—SI.-—-Date of Bi Volunteer Name —9--YAtiitha Volunteer 1b Category Family Income fora month Dry Land holding of family Wet Land holding of Family Four-wheeler in Family (Yes/No) Govi. Employee in Family (Yes/No ~~ Electricity consumption Property in Municipal/Plinth area As Per System Validation FREE sje jefe income Tax payee in family ‘Any Other Pension in the family © jo ‘sepeiae Eligibefinctiaible: I Solemnity state that the above - mentioned particulars are true to the best of my knowledge and belief and that it conceals nothing and that no part of itis false. In case if found future that the declaration given above Is false, | am liable for prosecution. A fotetalatts slalen Sign of the Ward Welfare & Development Secretary