YSR PENSION KANUKA

Department of Rural Development – Govt of Andhra Pradesh

Aadhar card No :

Name of the Date of Birth Gender Secretariat Secretariat Volunteer Volunteer

beneficiary ID Name Name contact number

District Mandal Secretariat ID

Secretariat Panchayat Habitation

name
Pension Gender
Scheme
First Name Relation Type Relative Name

Date of Birth Age Marital Status

Street House No Phone No

Caste Family Monthly

Income
Remarks Upload Medical
Certificate

Bank Entry Details

Account No Re-enter Account
Account No Holder Name
Bank Name IFSC Code
Branch Name
Description of the Beneficiary Condition:

Signature of the Village/Ward Secretary ANM Signature of the Medical Officer

(With Seal)