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AIAG AAAI
‘emeee eg / Enrolment No. 1040/10637/58625
2NGEE* Bea Qs / Your Aadhaar No. :
8304 1003 4762
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18304 1003 4762
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KADHAAR
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INFORMATION
' Aadhaar is proof of identity, not of citizenship.
* To establish identity, authenticate online,
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'= Aadhaar will be helpful in availing Goverment
‘and Non-Government services in future.
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Sacll Sect tmpowerment of Persons With Dsabiltes Department,
‘Government of Odahe
Madhu Babu Pension Yojana Application Form
Sats taper Stabe
Seas
”
4 Pension Yojana Application Form
Pension Type
Fathers/spouse
Mobile No
Sub-dvision
viage
House No/Piot
Category(caste)
‘cender
Mai
Old Age
Pension be!
RAMACHANDRA
SAHOO ne
6 ‘Aadhar No
Female
8249497345 Distet
KAMAKHYA, aasress
NAGAR Type)
PARAJANG or
AMBAPALAS Habitation
osc
BASANTI SAHOO
14-08-1962
seeenene4762
DHENKANAL
Block
AMBOPALASA,
AMBAPALAS
759120 The been’
parental/family convicted
Income of the of any
applicant ie not Yes Shminsl Yes
‘mora than offence
Rs. 60,0000-per tavelwing
turptude
resident/domicile Application
Seine Yes ‘eleston - sSEpp/BNFAPP/MBPY/03/04/2024/426746
20 years
Bank Acoount Detail
‘Bank Account Type Single Account ‘Account Holder Name BASANTI SAHU
‘Account Number 7860110130315 FSC Code uceag000786
Bank Name Branch Name PARJANG
Declaration
| Mr/Mrs BASANT! SAHOO truely declare that:
‘The parental/family income of the applicant is not more than Rs.60,000/-per annum,
Has not been convicted of any criminal offence involving moral turpitude.
{8 permanent resident/domicile of Odisha since 20 years,
| hereby declare that the detsils furnished above al
knowledge and belief and | undertake to Inform you of any changes therei
true and correct to the best of my
[Link] case any of
the above information is found to be false or untrue or misleading or misrepresenting, | am aware that I
‘may be held liable for it and that my pension will be terminated.
