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Application for New Ration Card

District

Ranga Reddy

Mandal/Municipality

District Ranga Reddy Mandal/Municipality FP Shop No.

FP Shop No.

District Ranga Reddy Mandal/Municipality FP Shop No.

Card Number (For Splitting/Addition):

FP Shop No. Card Number (For Splitting/Addition): 1. Family Head (along with Surname) : 2. Father/Husband
1. Family Head (along with Surname) : 2. Father/Husband Name : 3. Address : PIN
1. Family Head (along with Surname)
:
2. Father/Husband Name
:
3.
Address
:
PIN
Code:
4.
Family Members Details:
S.No
Name
Relationship
Gender
Age
Verified
1.
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

: Private Formal Sector (Salary more than 5000 p.m)

11.

Annual Income

:

12. Mobile No / Mail ID / Phone No

:

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

Signature/Thumb Impression of the Card Holder

Name:

Name:

,

Government

, Others

Signature of the Officer

------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------

Family Head Name:

Slip to be given to Beneficiary

Signature of the Officer

Name: