Ration Card and Member Personal Details
Personal Details
Photograph of Member


File Type: jpeg/png/jpg, File Size: 0-100 kb  *
 
Ration Card No.
Application No.
Member Name (LL)  * translate
Member Name (EN)  *
Spouse’s Name (LL)
Spouse’s Name (EN)
Father’s Name (LL) *
Father’s Name (EN) *
Mother’s Name (LL) *
Mother’s Name (EN) *
Gender *
Relationship with HoF *
DoB Type *
Age (Yrs) *
Date of Birth* (dd/mm/yyyy)
Mobile No.
Nationality
Other Details
Ration Lifting Eligibility
UIDAI/Aadhaar No.
 

eg. (1234/5678/9123)
Professional Details
Occupation*
Annual Income(in Rs.) *
Birth Certificate
Document Type *
Document Number *
Document Issue Date *
Birth Certificate *
Bank Details
Bank Name
State
District
Branch Name
Bank A/C No.
IFSC Code
Special Category
Special Category
MNREGA
MNREGA Status *
MNREGA ID *
Caste Category
Caste Category *
Caste Certificate

Disability Details
Any Disability?


Disability Since *
Disability Type *
Disability Due To *

Percentage option(%) * (For Example:30%,40% ....100%)
Certificate of Disability (Issued by CMO) *
Critical Illness
Any Critical Illness?
 

Critical Illness Since *
Critical Illness Type *
Critical Illness Certificate *
Remark:

 I agree to the Terms & Conditions and give my consent to store my Aadhaar number in encrypted format in a secured manner as per the guidelines issued by UIDAI to use various authentication services provided in the PDS application softwares.

 I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately.
In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

Note: * Mandatory fields

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