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Annual Income*: _______________________________________
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Residence Address
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District*: ________________________
________________ Mandal*: ___________________________
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______________________ Pin Code: ____________________
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FP Shop No*: ______________________________
Permanent Address
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_____________________ Mandal*: _________________________
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Gend
DOB
Mother
Father
Spouse
Opting to
Name
er
(DD/MM
Name
Name
Name
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with Head
Commodity
of the
(True/False)
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/YYYY)
Age
EID
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