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FORMAT

APPLICATION FORM FOR ISSUE OF NEW RATION CARD / RENEWAL OF RATION CARD 1. Name of the Applicant (In block letters) 2. Fathers Name 3. Present Address: Village / Colony / Sector House Number. 4. Permanent Address: Village / Colony / Sector House Number. 5. Inner Line Pass No. (In case of Non-Arunachalees) 6. Occupation / Designation. 7. Name of the Employer / Department . . ...

8. Details of the family members. Adult .. Minor .. Sl. No. 1 2 3 4 5 6 7 8 9 Name in full Age Sex Relationship with the applicant

9. Electoral Roll No. / Census No. 10. Trading Licence No. (In case of business community) 11. LPG Consumer No.

I do hereby declare that the particulars of my family members shows above are correct to the best of my knowledge and belief I do not possess any Ration Card in my name or in the names of above family members.

Signature of Applicant Date

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