3/30/23, 8:10 PM Application Form Definition

View Application Details for Local Residence (Domicile) Certificate

Application Number 16465344

Applicant's Basic Information

Name of the Applicant Mr. Sanjay Prasad Barnwal

Date of Application 30/03/2023

Date of Birth 05/12/1968

Age 54

Gender Male

Mobile No 9970309115

E-mail barnwalsanjay393@gmail.com

Aadhaar Card No ********2518

Permanent Address of Applicant

Country India

State West Bengal

District Paschim Bardhaman

Sub-division Asansol

Rural or Urban Urban

Block/Municipality/Municipal Corporation Municipal Corporation

Block/Municipality/Municipal Corporation Name Asansol

Village or Ward Ward No 86

Police Station Asansol South

Post Office Asansol

Address Line 1 Chaitanya Niwas, Flat No.02, Floor No.03,

Address Line 2 Milan Samity Gali, Mohishila Simultala, Asansol

Pin Code 713303

Present Address of Applicant

Country India

State West Bengal

District Paschim Bardhaman

Sub Division Asansol

Rural or Urban Urban

Block or Municipality or Corporation Municipal Corporation

Block or Municipality or Corporation Name Asansol

Village or Ward Name 86

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3/30/23, 8:10 PM Application Form Definition

Police station Asansol South

Post Office Asansol

Address Line 1 Chaitanya Niwas, Flat No.02, Floor No.03,

Address Line 2 Milan Samity Gali, Mohishila Simultala, Asansol

PIN Code 713303

Parent or Husband details

Parent or Husband Father

Salutation Late

First Name Shyam

Middle Name Sundar

Last Name Barnwal

Occupation Business

Details of Parents Business or Service

Applicant Place of Birth

Country India

State Other

District

Sub Division

Rural or Urban

Block or Municipality or Corporation

Block or Municipality or Corporation Name

Village or Ward Name

Police station

Post Office

Address Line 1 Balidiha, Jamui

Address Line 2 Bihar

PIN Code 811308

Education Detail of Applicant

Education Detail of Applicant

Record :1

Name of Institution Anugrah H.S Jhajha Class From VI

Class To XII From Year 1961

To Year 1969

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Particulars of stay of last 15 years

Particulars of stay of last 15 years

Record :1

Country India State West Bengal

District Paschim Bardhaman Sub Division Asansol

Block or Municipality or
Rural or Urban Urban Municipal Corporation
Corporation
Block or Municipality or
Asansol Village or Ward Name Ward No.86
Corporation Name
Police station Asansol S Post Office Mohishila Colony SO
Chaitanya Niwas, Flat Milan Samity Gali, Mohishila
Address Line 1 Address Line 2
No.02, Floor No.03, Simultala, Asansol
PIN Code 713303 From Date 09/02/2006

To Date 29/03/2023 House Type Owned

Other Details

Applicants Details of Business or service Railway Employ

Native State West Bengal

Native District PASCHIM BARDHAMAN

Duration of Stay in West Bengal 15

Whether Applicant or Parents Possess Any Immovable
Property Like House etc. in West Bengal or in Any Other No
State
Immovable Property Details
Whether Applicant Migrated from Any Other State or
Yes
Country
Reason for Application Other

Other Reason for Application Residential address proof for applying for any loan

Supporting Document List

Residential Proof Photograph Birth Proof Identity Proof Any other relevant
document.

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