ASSESSMENT FORM - HOUSE DAMAGED

DISTRICT CHARSADDA.

Name of Tehsil

Address, CNIC No. & House Damages

Name of Affected
Father’s Name Contact number of the Date of Incident Reason for Damages
House Owner
Affected Person Fully Damage Partially Damage Detail of damage

1. Name & Designation of

Representative of C&W Division Charsadda: Signature _

2. Name & Designation of

Representative of Irrigation Sub-Division Charsadda: Signature _

3. Tehsildar of concerned Revenue Circle: _____________________ 4. AAC of concerned Tehsil: ___________________________

(Signature with stamp) (Signature with stamp)

AC of the concerned Tehsil (Chairperson): __________________

(Signature with stamp)
 ASSESSMENT FORM – DEATH/INJURED
DISTRICT CHARSADDA

Name of Teshil: ___________________

S.No Date of Report by R.F.S Date of incident Particulars of affected person (Name, Father Name, CNIC No, Address ) Reasons of Death/injured
(Death/Injured)

1. Name of Halqa Patwari/Moharrar: ____ Signature _

2. Name of Local School Principal/Head Master: ______ Signature _

3. Tehsildar of concerned Revenue Circle: _____________________

(Signature with stamp)

AC/AAC of the concerned Tehsil (Chairperson): _______________________

(Signature with stamp)
 ASSESSMENT FORM – PERISHED CATTLES
DISTRICT CHARSADDA

Name of Teshil: ___________________

Nos of Animals and Cattles
Name of Owner Father Name Date of Incident CNIC No/Adress 05 big and 10 small
Cause of death
Small (Goat, Sheep) Big (Cow, Bubbalo, Horse,
Camel and Donkey)

1. Name of Halqa Patwari/Moharrar: ____ Signature _

2. Name of Local School Principal/Head Master: ______ Signature _

3. Name & Designation of

Representative of Livestock Department:_________________________________________________ Signature______________________

4. Tehsildar of concerned Revenue Circle: _________________________________________________ Signature______________________

(Signature with stamp)

AC/AAC of the concerned Tehsil (Chairperson): _______________________

(Signature with stamp)
 ASSESSMENT FORM – AGRICULTURE
DISTRICT CHARSADDA

Name of Teshil: ___________________

Date of Report by Date of incident Name, Father Name, CNIC No, Address Crops in Acres/Trees in Orchard Reasons for Damages
R.F.S

1.
1.
1.
N

ame of Halqa Patwari/Moharrar: ____ Signature _

2. Name & Designation of

Rep: of Agriculture Department __________________ Signature _

3. Tehsildar of concerned Revenue Circle: _____________________

(Signature with stamp)

AC/AAC of the concerned Tehsil (Chairperson): _______________________

(Signature with stamp)
 ASSESSMENT FORM – DEATH/INJURED
DISTRICT CHARSADDA
(Civilian Victims)

Name of Teshil: ___________________

S.No Date of Report by R.F.S Date of incident Particulars of affected person (Name, Father Name, CNIC No, Address ) Reasons of Death/injured
(Death/Injured)

1. Name of Halqa Patwari/Moharrar: ____ Signature _

2. Tehsildar of concerned Revenue Circle: _____________________ 3. ASP/DSP of concerned circle: _______________________

(Signature with stamp)

AC/AAC of the concerned Tehsil (Chairperson): _______________________

 ASSESSMENT FORM – VEHICLE
DISTRICT CHARSADDA
(Civilian Victims)

Name of Teshil: ___________________

S.No Date of Report by Date of incident Particulars of affected person (Name, Father Name, CNIC No, Vehicle Type Reasons
R.F.S Address )

1.
1.
1.
N

ame of Halqa Patwari/Moharrar: ____ Signature _

2. ETO:__________________________ 3. ASP/DSP of concerned Circle:___________________

4.Tehsildar of concerned Revenue Circle: _____________________

(Signature with stamp)

AC/AAC of the concerned Tehsil (Chairperson): _______________________

 ASSESSMENT FORM – LIVESTOCK
DISTRICT CHARSADDA
(Civilian Victims)

Name of Teshil: ___________________

S.No Date of Report Date of incident Particulars of affected person (Name, Father Name, CNIC Nos of Animals and Cattles
by R.F.S No, Address )
Reason
Small (Goat, Sheep) Big (Cow, Bubbalo, Horse,
Camel and Donkey)

1. Name of Halqa Patwari/Moharrar: ____ Signature _

2. Name of representative of Livestock:____________________________________________________ Singnature_____________________

3. Tehsildar of concerned Revenue Circle: _____________________ 4. ASP/DSP of concerned Circle: ______________________

(Signature with stamp)

AC/AAC of the concerned Tehsil (Chairperson): _______________________

 ASSESSMENT FORM – HOUSES AND SHOP, KIOSK, PETROL PUMP ETC
DISTRICT CHARSADDA
(Civilian Victims)

Name of Teshil: ___________________

S.No Date of Report by Date of incident Particulars of affected person (Name, Father Name, CNIC No, Damage Type Reasons
R.F.S Address )

1. Name of representative of C&W Department:_____________________________________________ Signature:______________________

2. Name of representative of C&W Department:_____________________________________________ Signature:______________________

4.ASP/DSP of concerned Circle:___________________ 5.Tehsildar of concerned Revenue Circle: _____________________

AC/AAC of the concerned Tehsil (Chairperson): _______________________