Application No.

FAMC
CHECK SLIP FOR FAMILY MEMBER CERTIFICATE

Procedure:
1) Application form *
2) Ration Card copy/EPIC Card/Aadhaar Card* 3)Death Certificate *
*-Mandatory

Name of the Applicant

Father / Husband Name

Address

Conduct of enquiry at door level

Is the applicant
Govt.Employee
/ Beneficiary under social security scheme
VRO like
1
Aapathbandhu/CMRF etc.

Statement recorded
from applicant / family members

Mediators statement

Recommendation of the VRO

Signature of the VRO

Verification of
report of the VRO
Verification of records
produced by the applicant
MRI
2
Recommendation of the RI

Signature of the RI

Verification of
Remarks from RI & VRO

Office Remarks of Office Assistant

3
Assistant
Name of the Office
Assistant
Verification of
Remarks from RI & VRO

Deputy Remarks of Deputy Tahsildar

4
Tahsilda
r
Name of the Deputy
tahsildar
Preparation of
Certificate

Signature of the Tahsildar

5 Tahsildar

Dispatched on