Y.S.R Pension Kanuka New Applica Grama/Ward Sachivalayam 1 | Applicant Name 2°| Aadhaar Number* 3_| Ration Card Number 4 | Pension Catagory* (OAP/Widow/Disabled/Single Women/Weavers/Toddy Tappers/Fishermen/Transgender) 5 | sachivalayam Name & Code 6 | Volunteer Name & CFMS ID 7_| Panchayat* 8 | Habitation* 9 | Relation Type & Relation Name* (8/0, 0/0, F/0, M/O, H/0, W/O, C/O, SELF) 10 | Age & Date of Birth* 11 | caste* 12 | Sub Caste* 13 | Gender 14 | Marital Status* 15 | Address 1* 16 | Address 2 17 | Contact Number* 18 | Family Income For Month* 19 | Dry Land holding of Family (in acers)* 20 | Wet Lanid holding of Family (in acers)* 21 | Four wheeler in Family (Yes/No}* if yes, mention details 22 | Govt. Employee in Family (Yes/No)* If yes, mention details 23 | Electricity consumption (in units)* 24 | Property in Municipal/Plinth Area (in Sq Ft)* 25 | Income Tax payee in Family (Yes/No)* If yes, mention details 36 | Anv other Pension in Family (EPF/Military/OTHERS) (Yes/No)*Attached Documents Checklist (Yes/No)* 1. Applicant Aadhaar Card 2. Ration Card 3. Age Proof (Aadhar/Birth Certificate/Study Certificate/Medical Certificate etc.) 4. Scheme Proof Certificate (Widow/Single WomenWeavers/Taddy Tappers/Fishermen/Transgender) 5, SADAREM Certificate (Disabled) 6. Integrated Certificate (Caste Certificate) 7. Other Supporting Documents (if any) Applicant Signature/Thumb Impression Volunteer Name & Signature