Beruflich Dokumente
Kultur Dokumente
Card No
: 365370743511
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 263593328548
: P Vijaya
Father/Husband Name
:-
Address
: 4-1-114,ATTAPUR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
Name
UID
Photo
P Vijaya
263593328548
283509247785
P Shashikanth Reddy
452237076434
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743533
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 335297866936
: Anugula Yadamma
Father/Husband Name
:-
Address
: 4-4-170,ATTAPUR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Anugula Yadamma
UID
Photo
335297866936
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743538
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 860619372671
: K Yadamma
Father/Husband Name
:-
Address
: 4-2-125,4-2-125, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
K Yadamma
UID
Photo
860619372671
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743557
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 691311417178
: Qasim Bee
Father/Husband Name
:-
Address
Mandal
Name
UID
Photo
Qasim Bee
691311417178
: 4-3-119/5/A,4-3-119/5/A,
Attapur, Attapur, Ward-1(V)
796923330703
: CIRCLEIII(SAROORNAGAR)
749351877267
District
: Ranga Reddy
Gas Connection :
: Yes
: 30205
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743573
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 414600220915
: Devamainolu Lakshmamma
Father/Husband Name
:-
Address
: 4-3-27,4-3-27, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Devamainolu Lakshmamma
414600220915
D Durga Bai
459383943525
D Ramu
907705098926
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743592
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 888173556020
: Devi Sharma
Father/Husband Name
:-
Address
: 4-6-90/2/2,4-6-90/2/2,T N
COLONY HASSAN NAGAR
RAJENDRANAGAR
RANGAREDDY
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
Name
UID
Photo
Devi Sharma
888173556020
Ramprasad Sharma
306145177366
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743606
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 899775328277
: Guntthapally Padmavathi
Father/Husband Name
:-
Address
: 4-4-6/1,4-4-6/1,ATTAPUR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 656724
Name
UID
Photo
Guntthapally Padmavathi
899775328277
Gunthapally Parvathamma
776384375000
Guntthapally Narayan
Reddy
518060330935
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743630
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 415148986262
: Chilkuru Balamani
Father/Husband Name
:-
Address
: 4-4-97,4-4-97, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 08962
Name
UID
Photo
Chilkuru Balamani
415148986262
C Nagaraju
294164013095
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743701
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 471427188675
: P Jayasudha
Father/Husband Name
:-
Address
: 4-2-99,4-2-99, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 636464
Name
UID
Photo
P Jayasudha
471427188675
P Naveen
673236891236
P Sneha
702886721593
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743797
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 212462619049
: Jaligam Anuradha
Father/Husband Name
:-
Address
: 4-1159,attapur(M),Hyderabad(D)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Jaligam Anuradha
212462619049
J Pavanamma
989276816612
Jaligam Shankar
413827383287
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743866
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 564462428871
: Kamadanam Suguna
Father/Husband Name
:-
Address
: 4-4-100,4-4-100, Attapur,
Bhagya Nagar, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 12468
Name
Kamadanam Suguna
UID
Photo
564462428871
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743888
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 252269962863
: A Padmamma
Father/Husband Name
:-
Address
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 1004135
Name
UID
Photo
A Padmamma
252269962863
A Ramulu
434194823985
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743927
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 791316399435
: D Manemma
Father/Husband Name
:-
Address
: 4-3-25/1,4-325/1,POCHAMMA BASTHI
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
D Manemma
791316399435
D Radika
756201159845
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743938
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 424603322804
: Pannala Anjamma
Father/Husband Name
:-
Address
: 4-1-92,4-1-92, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Pannala Anjamma
UID
Photo
424603322804
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743950
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 271708519661
: Rudraram Narsimha
Father/Husband Name
:-
Address
: 4-2-119/1,4-2-119/1, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Rudraram Narsimha
271708519661
Rudraram Balamma
699623818782
Rudraram Pallavi
681628262107
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370743985
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 226633211179
: P Janamma
Father/Husband Name
:-
Address
: 4-1-86,4-1-86, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
P Janamma
UID
Photo
226633211179
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744006
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 794012943417
: Radhika
Father/Husband Name
:-
Address
: 4-5-40/3/A,4-5-40/3/A, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
Name
UID
Photo
Radhika
794012943417
A Madhu
658638100291
Madhavi
720347352707
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744026
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 613812680929
: K Pochamma
Father/Husband Name
:-
Address
: 4-3-18,ATTAPUR RAJENDRA
NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
K Pochamma
613812680929
K Manikyam
802573730778
K ANITHA
331474825326
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744028
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 794448161084
: D Pemtamma
Father/Husband Name
:-
Address
: 4-3-75,4-3-75,POCHAMMA
BASTHI
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
D Pemtamma
UID
Photo
794448161084
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744036
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 992741072684
: Mamidi Saroja
Father/Husband Name
:-
Address
: 4-4-99,4-4-99, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Mamidi Saroja
UID
Photo
992741072684
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744039
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 529884377735
: Gurram Yadamma
Father/Husband Name
:-
Address
: 4-2-97,4-2-97, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Gurram Yadamma
UID
Photo
529884377735
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744041
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 394649753738
: Riyasat Begum
Father/Husband Name
:-
Address
: 4-3-129/2,ATTAPUR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Riyasat Begum
394649753738
642632742364
Amreen Sultana
988762902933
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744080
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 314439585578
: Yata Swaroopa
Father/Husband Name
:-
Address
: 4-1-193,4-1-193, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Yata Swaroopa
UID
Photo
314439585578
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744097
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 750488994923
: Vaddla Lalitha
Father/Husband Name
:-
Address
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
Name
UID
Photo
Vaddla Lalitha
750488994923
V Upender
850742911378
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744113
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 693922856914
: P Yadamma
Father/Husband Name
:-
Address
: 4-1-12,4-2-87, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
P Yadamma
UID
Photo
693922856914
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744120
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 852914831778
: M Shobharani
Father/Husband Name
:-
Address
: 4-1-142/1,RAJENDRA
NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 602819
Name
M Shobharani
UID
Photo
852914831778
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744140
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 507193382392
Father/Husband Name
:-
Address
: 4-7-113,4-7-113, Attapur,
Shivaji Nagar, Ward-3(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
Name
UID
Photo
507193382392
Satish
592842941281
Santosh
951200922028
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744166
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 351564464975
: Savitramma Solanki
Father/Husband Name
:-
Address
: 4-2-17/1/C/1,ATTAPUR
RAJENDRA NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Savitramma Solanki
351564464975
Radha Solanki
366594551017
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744179
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 574706144869
: Mahammadi Begam
Father/Husband Name
:-
Address
: 4-3-130/8/1,4-3-130/8/1,
Attapur, Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 17662
Name
UID
Photo
Mahammadi Begam
574706144869
Afreen Sultana
895838909126
328740937192
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744197
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 489620133577
: Durgamma
Father/Husband Name
:-
Address
: 4-3-9/1/A,4-3-9/1/A, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Durgamma
489620133577
K Mallesh
989362089819
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744202
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 471963125720
: Kota Sumalatha
Father/Husband Name
:-
Address
: 4-1-172/4/1/3,ATTAPUR
RAJENDRA NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 612937
Name
UID
Photo
Kota Sumalatha
471963125720
Prathibha
338639139391
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744205
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 663544959991
: Gummadi Muttamma
Father/Husband Name
:-
Address
: 4-1-50,4-1-50, Attapur,
Attapur, Ward-6(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
Name
UID
Photo
Gummadi Muttamma
663544959991
764418682190
712492267134
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744213
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 551073171342
: Nagu Bai
Father/Husband Name
:-
Address
: 4-6-38,4-6-38, Attapur,
Rambagh, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Nagu Bai
551073171342
M Narsu Bai
224005350527
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744249
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 437638029204
: Soyaamuthyam Satyamma
Father/Husband Name
:-
Address
: 4-2-108/1,4-2-108/1, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 12654669
Name
UID
Photo
Soyaamuthyam Satyamma
437638029204
S Srinu
726351301517
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744268
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 348558041155
: Panthula Kamalamma
Father/Husband Name
:-
Address
: 4-1-76/2,4-1-76/2, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Panthula Kamalamma
UID
Photo
348558041155
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744285
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 718636766837
: Kallem Komarama
Father/Husband Name
:-
Address
: 4-4-62,4-4-62, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 32350
Name
UID
Photo
Kallem Komarama
718636766837
K Mahipal Reddy
766012944560
K Babu Reddy
887331334455
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744298
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 424801049411
: Paka Susheela
Father/Husband Name
:-
Address
: 4-2-17/2,4-2-17/2,ATTAPUR
NEAR TATION HYD
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 20296
Name
Paka Susheela
UID
Photo
424801049411
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744311
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 261409164190
: Pendur Anjamma
Father/Husband Name
:-
Address
: 4-2-105,4-2-105, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 658032
Name
UID
Photo
Pendur Anjamma
261409164190
Malathi
630268206531
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744328
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 463295798052
: B Sarojana
Father/Husband Name
:-
Address
: 4-4-71,4-4-71, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
B Sarojana
463295798052
B Venkataiah
997375014188
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744363
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 447289307152
: Kota Gandamma
Father/Husband Name
:-
Address
: 4-3-17,4-3-17, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Kota Gandamma
447289307152
K Shankar Bai
250741345674
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744402
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 776660922655
: M D Shahajadi Begum
Father/Husband Name
:-
Address
: 4-3-103/6,ATTAPUR
RAJENDRA NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
M D Shahajadi Begum
776660922655
Mohd Aleem
897336462151
Nayeem
714956012109
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744462
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 658608919489
: Metla Sabitha
Father/Husband Name
:-
Address
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 802560
Name
Metla Sabitha
UID
Photo
658608919489
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744463
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 479485033255
: Chirra Ramaiah
Father/Husband Name
:-
Address
: 4-4-109,4-4-109, Attapur,
Bhagya Nagar, Ward-2(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Chirra Ramaiah
479485033255
C Narsamma
848069184738
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744471
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 298999981229
: Samala Ramulamma
Father/Husband Name
:-
Address
: 4-1-76,4-1-76, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 610790
Name
Samala Ramulamma
UID
Photo
298999981229
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744474
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 806697355483
: Puppala Anasuya
Father/Husband Name
:-
Address
: 4-2-140/2,4-2-140/2, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Puppala Anasuya
806697355483
P Naresh
538444859132
P Harish
200303879681
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744503
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 404274450433
: Soyam Kamalamma
Father/Husband Name
:-
Address
: 4-2-85/1,4-2-85/1, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Soyam Kamalamma
404274450433
Soyam Chander
360333643614
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744504
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 418988366827
: Raziya Begum
Father/Husband Name
:-
Address
: 4-3-130/12,4-3-130/12, Attapur,
Khaja Nagar, Ward-7(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 23717
Name
UID
Photo
Raziya Begum
418988366827
Naseem Begum
863462153287
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744509
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 900152011666
: Dumpala Sathamma
Father/Husband Name
:-
Address
: 4-1-40,4-1-40, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Dumpala Sathamma
UID
Photo
900152011666
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744511
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 288857622570
: K Prabhavathi
Father/Husband Name
:-
Address
: 4-2-26,ATTAPUR RAJENDRA
NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 2274963
Name
UID
Photo
K Prabhavathi
288857622570
K Saiteja Reddy
986716259397
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744528
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 292961912769
: Goska Ramulamma
Father/Husband Name
:-
Address
: 4-1-75,4-1-75, Hyderguda,
Attapur, Ward-7(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 610784
Name
Goska Ramulamma
UID
Photo
292961912769
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744534
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 425454041026
Father/Husband Name
:-
Address
: 4-7-156/9/A,4-7-154/9/A,
Attapur, Pandu Ranga Nagar,
Ward-3(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
Name
UID
Photo
425454041026
B Naganath
410909208079
B Balaji
398668668702
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744544
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 359663399564
: Konda Satyamma
Father/Husband Name
:-
Address
: 4-2-18/4,ATTAPUR
RAJENDRA NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 66082
Name
UID
Photo
Konda Satyamma
359663399564
979758689145
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744572
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 506015391310
Father/Husband Name
:-
Address
: 4-3-130/8/1,4-3-130/8/1,
Attapur, Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 17662
Name
Mohammed Noorjahan
Begum
UID
Photo
506015391310
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744628
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 358206351444
: N Rajamani
Father/Husband Name
:-
Address
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 624969
Name
UID
Photo
N Rajamani
358206351444
N Raju
999167238423
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744696
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 890716042703
: Tenugu Sathamma
Father/Husband Name
:-
Address
: 4-1-34,4-1-34, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Tenugu Sathamma
890716042703
Gudepu Susheela
506607992783
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744773
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 484148157927
: Anugula Jyothi
Father/Husband Name
:-
Address
: 4-1-36,ATTAPUR RAJENDRA
NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 15495
Name
UID
Photo
Anugula Jyothi
484148157927
557519801210
971885605564
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744806
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 406425486966
: Kamar Sultana
Father/Husband Name
:-
Address
: 4-3-103/7/1,4-3-103/7/1,
Attapur, Kanta Reddy Nagar,
Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Kamar Sultana
406425486966
Sumayya Kausar
383782161642
Mohammed Nawaz
731894234695
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744839
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 533172033368
Father/Husband Name
:-
Address
: 4-4-3,4-4-3, Attapur,khaja
nagar
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 17902
Name
UID
Photo
533172033368
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744903
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 968215126409
Father/Husband Name
:-
Address
: 4-7-156/3/C,4-7-156/3/C,
Attapur, Panduranga Nagar,
Ward-3(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: 33932
Name
UID
Photo
968215126409
Chanabasva
728447600692
Vishal
265954036509
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744931
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 915901392210
: Suddula Shyamala
Father/Husband Name
:-
Address
: 4-3-101,4-3-101, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: CX5737983
Name
UID
Photo
Suddula Shyamala
915901392210
Suddula Anand
420363278786
S Sarada
257196879636
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370744954
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 909804364310
: Disouja Elizabeth
Father/Husband Name
:-
Address
: 4-3-130,4-3-130, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
: CX5771836
Name
Disouja Elizabeth
UID
Photo
909804364310
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370745044
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 659095808297
: Devamola Lakshmaiah
Father/Husband Name
:-
Address
: 4-3-14,4-3-14, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
Devamola Lakshmaiah
659095808297
D Gandamma
493635924837
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370745088
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 660425999114
: Sohra Bee
Father/Husband Name
:-
Address
: 4-3-103/7/1,ATTAPUR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: Yes
Name
UID
Photo
Sohra Bee
660425999114
Md Abdul Khadar
929205849277
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370745098
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 526619869549
: S Durgamma
Father/Husband Name
:-
Address
: 4-3-50,attapur RAJENDRA
NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
S Durgamma
UID
Photo
526619869549
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370745142
Card Type
: AFSC
F.P Shop No
: 1583005
UID
:-
:-
Father/Husband Name
:-
Address
: 4-7-175/1,4-7-175/1, Attapur,
Panduranga Nagar, Ward-3(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
UID
Photo
555779161360
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370745168
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 615453568651
: Devanamahina Durgamma
Father/Husband Name
:-
Address
: 4-3-68/1,4-3-68/1, Attapur,
Attapur, Ward-1(V)
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Devanamahina Durgamma
UID
Photo
615453568651
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre
DECLARATION FORM
Card No
: 365370806262
Card Type
: AFSC
F.P Shop No
: 1583005
UID
: 431719378205
: Kashigari Kistamma
Father/Husband Name
:-
Address
: 4-1-57/1,
ATTAPUR,RAJENDRA
NAGAR
Mandal
: CIRCLEIII(SAROORNAGAR)
District
: Ranga Reddy
Gas Connection :
: No
Name
Kashigari Kistamma
UID
Photo
431719378205
CARD HOLDER
1. I have (
2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member
FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.
Page No.1
Signature
Tahsildar/ASO
Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre