rpm - ae HwWarocDso B0GaS5 DzbeAhs0 YSR Pension Kanuka Field Verification Form SECRETARIAT nameKaleklanpeln SECRETARIAT cope —LO002 4 _ Arba) --Agees—-aadhaar Number 3502-22- Md. Tsub...-.--- _-cast-B@E sub Cast HPs! y 165°2_ income Certificate No- JEP M0286 408 Habitation one - Name Of the Applicant Name of the Father/husban Rice Card Number-2818/ Gender- “1 mobile Number-—t2-. ~age—bly-—pate of Birth, 6) -.0 - Volunteer ID---2-A— Type Of the Pension Disable _ Volunteer Name —Rabiye 5.No | Category {As Per System Validation Details a Family Income fora month Rs.GOCO|..Per month [2 Dry Land holding of family 10) eee aeres las Wet Land holding of Family lg Four-wheeler in Family (Yes/No) 5 | Govt. Employee in Family (Yes/No. Yes/N é Electricity consumption D0... ae 7 Property in Municipal/Plinth area 0. a inS@Ft - | s Z Income Tax payee in family a | 9 Any Other Pension in the family | Yes/No ee jible/ineligibie: | Solemnity state that the above -mentioned particulars are true to the be: re true to st of my knowledge and belief and that it conceals nothing and that no part of itis false, In case if found future that the Gecera given above is false, | am liable for prosecution. ei A fushpobess. as|pfoo., Sign of the Ward Welfare & Development Secretary