Application for Identity Purpose Ration Card/Conversion from NFSA/RKSY to identity

purpose card Form 10

ভর্ত কু ি কিহীন (পকিচয় হহর্ত ) হিশন িার্ডুি আর্িদন অথিা
NFSA/RKSY হর্র্ি ভর্ত কু ি কিহীন (পকিচয় হহর্ত ) হিশন িাডু পকিির্ুর্নি আর্িদন

(*marked fields are compulsory)

Section A: Address and Contact Details*
District*
Sub-division*
Block/Municipality/ Municipal
Corporation*

Gram Panchayat/ Locality *

Village/Road/ Street *

Post Office*
Pin Code*
Police Station
Primary Mobile No* (for getting SMS from F&S Deptt.)
Alternate mobile/ whatsapp no.
email id (if any)
If you don’t want us to send e-bill and other important messages, tick the box

Section B: Applicant Details*

[ ] Please check this box if you or your family does not have any existing Ration Card or has never held a Ration Card. You need
not enter the details of Ration Cards in the table below.

Name*1

Date of Birth* D D M M Y Y Y Y Male Female Others

Father’s/Mother’s/Spouse’s Name
Aadhaar Card Number*
EPIC Number
Ration Card number*
Digital Ration Card Type* AAY PHH SPHH RKSY-I RKSY-II
Paper Ration Card Type AAY BPL APL Have no ration card at all
(Please Tick[√] in box)
Whether person with Disability (PWD) Yes No
Name*2

Relationship with the Head of Family*

Date of Birth* D D M M Y Y Y Y Male Female Others
Father’s/Mother’s/Spouse’s Name
Aadhaar Card Number*
EPIC Number
Ration Card number*
Digital Ration Card Type* AAY PHH SPHH RKSY-I RKSY-II
Paper Ration Card Type AAY BPL APL Have no ration card

Whether person with Disability (PWD) Yes No

You may also apply online. Visit www.wbpds.gov.in

 Name*3

Relationship with the Head of Family*

Date of Birth* D D M M Y Y Y Y Male Female Others
Father’s/Mother’s/Spouse’s Name
Aadhaar Card Number*
EPIC Number
Ration Card number*
Digital Ration Card Type* AAY PHH SPHH RKSY-I RKSY-II
Paper Ration Card Type AAY BPL APL Have no ration card

Whether person with Disability (PWD) Yes No

Name*4

Relationship with the Head of Family*

Date of Birth* D D M M Y Y Y Y Male Female Others
Father’s/Mother’s/Spouse’s Name
Aadhaar Card Number*
EPIC Number
Ration Card number*
Digital Ration Card Type* AAY PHH SPHH RKSY-I RKSY-II
Paper Ration Card Type AAY BPL APL Have no ration card

Whether person with Disability (PWD) Yes No

[ ] I agree that all inputs given above are true to the best of my knowledge. I agree that the application may be rejected, or the Ration
Card if issued, may be cancelled if any information furnished here is found to be false. I also acknowledge that other legal action may be
taken against me for furnishing wrong information or hiding any relevant information, either at the time of application or at later stage.

Date: Signature /LTI of the applicant

Check list of Documents to be added:

Copy of Aadhaar Cards of all applicants
Copy of existing Digital Ration Cards of all applicants in case of conversion from subsidised to non-subsidised ration
cards
If age of any new applicant is less than 5, then Aadhaar is not mandatory. In that case copy birth certificate of such
applicant is to be submitted.

___________________________________________________Receipt_______________________________________________________

Received Application vide Barcode Number______________________________________________ for Form _________

Date………………… Signature and seal

You may also apply online. Visit www.wbpds.gov.in