New Ration Card Application Form

Head of the Household Details

Card Type*:
APL
BPL
AAY
AAP
EID*: ________________________________________________
__________________________ UID*: _____________________
_____________________
Name of Head of the Family*:_______
______________________________________________________
_________________________________________________
Name of Head of the Family (In local language)
language)*: ________________________________________
____________________
Mother's Name*: ______________________________________________________________
______________________________________________________________
________________
Mother's Name (In local language)*: _________
___________________________________________________
______________________________________________________
Father's Name*: __________________
_____________________________________________________________________
_____________________________________________________________
Father's Name (In local language)*: ___________
______________________________________________________
____________________________________________________
Gender*:
Male
Female
Spouse's Name*: ___________________________________________________________
__________________________________________________________________________
____________________
DOB*: ______________________________
__________________________________ Age*: _____________

Professional Details
Occupation*: _________________________________________________________________________
_______________________________________________________________
______________________________________________________
Annual Income*: _______________________________________
_______________________________________________________________________________
________________________________________

Gas Connection Details

Gas Connection Status*:
Deepam
Double
Single
No Cylinder
Gas Company Name*: _______________ Gas Agency Name *: _______________________________________
_________________

Consumer No*:__________________________________
__________________________________

Residence Address
Door No *:: _______________________ Locality / Land Mark*:: ____________________________________
District*: ________________________
________________ Mandal*: ___________________________
__________________________________

Village / Ward *: ________________________

______________________ Pin Code: ____________________
________________________

FP Shop No*: ______________________________

Permanent Address
Door No *:: _______________________ Locality / Land Mark*:: ____________________________________
District*: _______________________
_____________________ Mandal*: _________________________
________________________________

Village / Ward *: _________________________

_________________________ Pin Code: _______________________
_________________
 Add Member Details:
YES
NO
If Yes, Please Enter Member Details
Member Gend DOB Mother Father Spouse Opting to Age EID UID Relationship
Name er (DD/MM Name Name Name Lift with Head
/YYYY) Commodity of the
(True/False) Family

Other Details
Old Ration Card No. (If any): _________________________________
______________________________________________________________
_______________________________

Informant Details
Informant Name*: ____________________
__________________________________ Informant Relation*: _________________________
Delivery Type*: _______________________________ Mobile No*: ______________________________________
________________________
Proof Document*: _______________________________________

Documents List (NOTE:

NOTE: 1.Total size of all Upload Documents should not be exceeding up to 50 KB.
2. All Upload Documents should be in PDF format only.
only.)

Meeseva Application Form*

Proof Document*

Photo*

Applicant’s Signature