2/12/2020 eDistrict_Portal_Receipt_Page

Applicant General Details

Reg.No : 26619709
Appl.No : 50474419
Name : MATHEW MATHEW
PALLIPURAM
Applied Date : 12-02-2020
Resubmitted / : _
Edited On
Certificate Type : Family Membership Certificate : State Purpose
Purpose
To be produced : General Date of Birth : 22-04-1951
before
Gender : Male Age : 68
Present Address : 607/8, PALLIPURAM Permanent : 607/8, PALLIPURAM
HOUSE, PANDANKARY, Address HOUSE, PANDANKARY,
Edathua(G), EDATHUA, Edathua(G), EDATHUA,
689573, Edathua, Kuttanad, 689573, Edathua, Kuttanad,
Alappuzha Alappuzha
No. of years residing at present address : 50.0
Father's Name : P M MATHEW Religion and : Christian,Christian
Caste of Father
Mother's Name : ANNAMMA MATHEW Religion and : Christian,Christian
Caste of Mother
Marital Status : Married Spouse Name : LESSY PALLIPURAM
Phone No. : _ Mobile No. : _
email : _
Ration Card : _ Driving Lic. No. : _
No.
Election ID : _ Passport No. : _
Card No.
UID : _ SSLC Reg No : _
SSLC Year : _

Family Membership Specific Details

Name and address of person with whom related/dependent
P M MATHEW
PALLIPURAM HOUSE, PANDANKARY, EDATHUA PO, EDATHUA 689573
SlNo. Name Gender Relation Age Occupation
1 MATHEW MATHEW PALLIPURAM Male Son 68 _
2 ANNAMMA MATHEW Female Wife 85 _
3 JOSE MATHEW PALLIPURAM Male Son 63 _
4 THOMAS MATHEW PALLIPURAM Male Son 65 _
5 VARGHESE PALLIPURAM Male Son 61 _
6 LOVELY THOMAS Female Daughter 58 _

Declaration
MATHEW MATHEW
Representative Name : Relationship : Self
PALLIPURAM
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