SIX STEP VALIDATION GRIEVANCE APPLICATION FORM

Applicant Details: -
Applicant Name : ______________________________________________________________________
S/o / W/o/C/o: ________________________________________________________________________
Date of Birth : _____________________________________Door No : __________________________
District : ___________________________________Mandal: ______________________________
Village : __________________________________________ Secretariat: _______________________
Mobile No : ______________________________________Type Of Scheme ____________________
Aadhar No: _________________________________________ Rice card No: _______________________

Corrections Required in Six Step Validation Details:

Land Income Tax Electricity 4-Wheeler Govt. Employee

CDMA New Enrollment Age Withheld Cast

Remarks By Applicant:

Declaration: -
I hereby declare that the above-mentioned information is correct up to my knowledge and I bear the responsibility
for the correctness of the above-mentioned.

Date:
Place: Applicant’s Signature

Remarks by Volunteer:

Volunteer Signature with Cluster Id Signature Of Digital Assistant

Proof Documents List should be attached.

Aadhar Card
Proof Letter