Application for New Ration Card

District

Ranga Reddy

Mandal/Municipality

FP Shop No.

Card Number (For Splitting/Addition):

1.

Family Head (along with Surname)

: ___________________________________________________________________

2.

Father/Husband Name

:____________________________________________________________________

3.

Address

: ___________________________________________________________________
_________________________________________PIN Code:__________________

4.

Family Members Details:

S.No
1.

Name

Relationship

Gender

Age

Verified

2.
3.
4.
5.
6.
7.
8.

5.

Beneficiary Group

: SC ____ ST ____ BC ____ Muslim ____ Christian ____ Others ____

6.

LPG Connection

: Yes ___ No ____

7.

House Status

: Owned _____ Rental _____

8.

House Type

: Kaccha ____ Semi-Pucca ____ Pucca (750 sft or less) ____,

Single /Multi-Stored (more than 750 sft) ____.

9.

Does the family have ISL?

(Individual Sanitary Latrine)
10. Occupation

: Yes _____ No _____

11. Annual Income

: _______________________

12. Mobile No / Mail ID / Phone No

: _______________________

: Private Formal Sector (Salary more than 5000 p.m) ________, Government ____, Others____

13. Recommended for White / AAY / Annapurna / Pink Card:

Signature/Thumb Impression of the Card Holder

Signature of the Officer

Name:

Name: ____________________________

------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------Slip to be given to Beneficiary

Family Head Name:

Signature of the Officer

Name: ____________________________