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NFSA Application Form

The document is a Family Identity Card/Ration Card Data Entry Form used in Assam for both existing card holders and new applicants. It includes mandatory fields for personal details of the head of the family, such as name, gender, date of birth, and contact information, as well as address and residence status. The form is part of the Assam Public Distribution System regulations and is essential for fresh verification or issuance of new cards.

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620 views5 pages

NFSA Application Form

The document is a Family Identity Card/Ration Card Data Entry Form used in Assam for both existing card holders and new applicants. It includes mandatory fields for personal details of the head of the family, such as name, gender, date of birth, and contact information, as well as address and residence status. The form is part of the Assam Public Distribution System regulations and is essential for fresh verification or issuance of new cards.

Uploaded by

ah081365
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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4292

THE ASSAM GAZETTE,


EXTRAORDINARY, JUNE 02, 2022

AnnexureI
FORM-С
Under rule 3(1)(viii) and rule 5 (2)(a)
FAMILY IDENTITY CARD/R
ATION CARD DATA ENTRY
FORM

(EXISTING CARD HOLDER/N


EW APPLICANT)- Please
Declaration of Head of the Family
tick (√)(to be given by local office)
of existing Family Identity Car
d/Ration Card holders for
fresh verification
Declaration of Applicant Hea
d of the Family for issue ofnew Family Identity
Card/Ration
Card
(See clause-2 (d) of the Assam Public Distribution
of Articles Order, 1982 AND clausa -2(m)
of clause-4of the Public read with paragrapи-2
Distribution System (Control) Order, 2001)
(All Fields marked with star are mandatory fields
a
and MUST be filled)

Card Type:
(APL/BPL/AAY/ MMASY Paste
* Card No.(Applicable for existing card Photograph
holders):
of Head of
1.PARTICULARS OF THE HEA
D OF THE FAMILY:
Family
*Name of Head of Family:

* Mother's Name:

*Father's Name:

Spouse Name:
* Gender:

*Date of Birth (dd/mm/yyyy):


Age:
Nationality:

Landline phone No.:


*Mobile No (for SMS Alerts):
* Bank A/C No.:
*Bank Name & Branch:

*Job Card No.:


5

* BPL SI. No.(for BPL Applicants):

1.(2)PRESENT ADDRESS:

*State:
* District:

* Sub-Division:
*Circle:
Rural/Urban Flag (R/U):
* Block:

GP /Town:
VCDC/ * Village/Ward:

Status of Residence-Own House/Rent


ed House:

* Name of House Owner (for rentedhouse


):

> Landmark/Locality/Colonу:
*PIN:

* Census House No

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