Form No.1

Application form for New Ration Card

 

( Especially for Municipal / Notified areas )

Fair Price Shop No…….. Present address of ……………………………

the applicant………………………………….

…………………………………………………

 Only for office use
Present Ration Card No. No. of members

eligible to be included in new Ration Card.

 Signature

of the

Inquiry

Officer

 Signature of the Supervisory Officer.
Name of the Head of the family with

other members.

 Whether they have ration

Cards, Yes or No.

 If not, what

is the reasons

behind it

 Ralationship

with the Head

of the family.

 Age Adult Minor    
     
                     

 

1) Name of Head of the Family &

Father’s/Husband’s name

………………………………….

…………………………………

2) Others :-

i)

ii)

iii)

iv)

vi)

vii)

viii)

…………………………………………………………………………………………………….

N.B. Present Ration Card is to be appended with it Applicant’s signature/thump impression

Counter foil.

Fair price shop No. Ration Card No. Name of the Head of family & Father’s/Husbands name. No.of family members Signature of the Inquiry officer.
Adult Half

Adult

 Total