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Application For New Food Security Card - Application Form

This document is an application for a new food security card. It collects personal details of the head of household such as name, age, gender, religion, and Aadhaar number. It also collects details of other household members. Gas connection and residence address details are provided. Documents required include the application form, Aadhaar proof, and address proof. The applicant's signature is also required.

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ShirishaVijayapuram
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© © All Rights Reserved
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16K views2 pages

Application For New Food Security Card - Application Form

This document is an application for a new food security card. It collects personal details of the head of household such as name, age, gender, religion, and Aadhaar number. It also collects details of other household members. Gas connection and residence address details are provided. Documents required include the application form, Aadhaar proof, and address proof. The applicant's signature is also required.

Uploaded by

ShirishaVijayapuram
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FOR NEW FOOD SECURITY CARD

Head of the Household Details


Card Type*:  FSC
UID (Aadhaar)*: ________________________ Name of Head of the Family*: __________________
HOF Father / Spouse Name*: _________________
Age*: _____________________________

Social Status*:  General

Gender*: Male Female Transgender

Religion*: _________________________________

 BC  SC  ST  OTHERS

Gas Connection Details


If Gas Connection is available:  YES

Gas Connection Status*:

 NO

 Deepam

Gas Company Name*:  BPCL

 Double

if YES
 No Cylinder

 Single

HPCL  IBP  IOCL  NA

Gas Agency Name *:______________________________________________________________


Consumer No*: _____________________________________

Residence Address
Door Number*: _____________________ Locality/Landmark*: __________________________
District*: ____________________________ Mandal*: ________________________________
Village/Ward*: _________________________ Pin Code*: ______________________________
FP Shop No*: ___________________________

SKS Form No: ___________________________

Add Member Details (Including HOF) *


AADHAAR NO.

EID

MEMBER NAME

SRDH NAME

AGE

GENDER

HOF

SRDH STATUS

RELATION WITH HEAD

YES/NO

Informant Details:
Informant Name*: _______________________

Informant Relation *: ______________________

Mobile No*: _________________________ Aadhaar Proof Document*: ____________________


Address Proof Document*: _________________________________
Delivery Type*: Manual  Local post
 Non Local post

Documents List:
(NOTE: 1.Total size of Upload Document should not exceed 3 MB.2. All Upload Documents should be in PDF Format Only)

1.
2.
3.

Application Form*
Aadhaar Proof Document*
Address Proof Document*

Applicants Signature

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