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Family Membership Certificate - Application Form: Applicant Details

This document is an application form for a family membership certificate. It requests information about the applicant such as name, address, contact details, and Aadhaar number. It also requests details about a deceased family member including name, date and cause of death, occupation, and Aadhaar number. The form includes spaces to provide details of up to 6 family members including their name, age, gender, relationship to the deceased, and Aadhaar number. It lists required documents to submit including the application form, affidavit with name/age/relationship of applicant to deceased, document showing relationship of applicant to deceased, and death certificate or FIR.

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saikumarreddy
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7K views2 pages

Family Membership Certificate - Application Form: Applicant Details

This document is an application form for a family membership certificate. It requests information about the applicant such as name, address, contact details, and Aadhaar number. It also requests details about a deceased family member including name, date and cause of death, occupation, and Aadhaar number. The form includes spaces to provide details of up to 6 family members including their name, age, gender, relationship to the deceased, and Aadhaar number. It lists required documents to submit including the application form, affidavit with name/age/relationship of applicant to deceased, document showing relationship of applicant to deceased, and death certificate or FIR.

Uploaded by

saikumarreddy
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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Family membership certificate -Application Form

Applicant Details
AADHAAR Card Number *:____________________________

Applicant Name * :_____________________________ Relation Name* ______________________________

Gender*:  Male  Female Date of Birth* (DD/MM/YYYY): _________________________________

Permanent Address:

Door No : ______________________________ Locality / Land Mark : __________________________

District*:_______________________________ Mandal*:__________________________

Village / Ward *:______________________________ Pin Code : ______________

Present Address:

Door No : ______________________________ Locality / Land Mark : __________________________

State*:______________________ District*:____________________ Mandal*:__________________________

Village / Ward *:______________________________________________ Pin Code : __________________

Mobile * : ________________________________ Phone :_______________________________

E-Mail: ________________________________ Remarks :_______________________________

Ration card NO :_______________________ Delivery Type*:  Manual  Local post Non Local post

Deceased Details:

Deceased Name* : ______________________ father/Husband Name * :_____________________________

Date of Death (DD/MM/YYYY)* : _____________________

Reason for Death* :  Accident Floods / Cyclones / Thunder Bolt Fire Accident  Drowning

 Collapse of buildings/Bridges  Ill health  General Death  Suicide  Missing  Murder

Occupation*:  State Government Services  Central Government Services  Public sector under takings
 Cooli  Agriculture Labor  Rickshaw Puller / Auto / Taxi / Lorry drivers/cleaners  Building
construction workers  Working in factories  Fishing  Other Occupations  Handloom Worker 
Retired Employee  Farmer  Business Man  Pensioner

AADHAAR Card Number: _______________________ Death place *____________________________________

Aadhaar Enrolment Number: Format (1234/12345/12345):______________________________


2.Name of the Family 3.Age* 4.Gender 5.Relationship with Maritial status 6.Aadhar
Member* Deceased* Number(UID) *

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. Application Form*
2. A notarized affidavit containing Name, Age and Relationship with deceased.*
3. Document (Ration card/ Voter ID Card/ Passport/ Passbook, Aadhar cards, etc.) indicating the
relationship of the applicant with the deceased*
4. Death Certificate/FIR*

Applicant’s Signature

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