APPLICATION FORM FOR ISSUE OF NEW RATION CARD/RENEWAL OF RATION CARD

1.

 Name of Applicant

 

2.

Father's Name .......................................

 

 

 

 

3. Present Address in full :

 

 

Name 

..

 

 

Village/Colony

..

 

 

House Number

.

 

4.

Permament Address in full

 

 

 

Name 

..

 

 

 Village/Colony

..

 

 

House Number

.

 

5.

Inner Line pass No (In case of Non Arunachalees)

....

 

6.

Occupation/Designation

 

7.

Name of Employer/Department

 

8.

Details of Femily Member            Adult  ..

Minor.

 

Sl.No.

Name in Full                      Age                  Sex

Relationship with Applicant

 

1.

...    .    ..

.

 

2.

    ..    .

.

 

3.

    ..    .

.

 

4.

   . .

.

 

5.

..    .. .

.

6.

...    .    .

.

7.

   . ...

.

 

 

 

9.

Electrol Roll No./Census No.

.

4.

Trading Licence No. (In Case of Business Community)

.

4.

L.P.G. Consumer.

.

        I do hereby decalare that the particulars of my family members shows above are correct to the best of my knowledge and belief I do not possess any femily Identity Card (Ration Card) in my name or in the name of above femily.

 

                                                                                        Signature of Applicant

                                                                                        Date