YSR CHEYUTHA 2023-24 APPLICATION FORM

SECRETARIAT DETAILS ::
Secretariat Name Secretariat Code
Volunteer Name Cluster ID
APPLICANT BASIC DETAILS ::
Applicant Name Spouse Name
Aadhar Number Gender
Date of Birth Age

Mobile Number Rice Card Number

Door Number Address

BANK ACCOUNT DETAILS ::

Bank Account Number IFSC Code
AADHAAR UPDATE
HISTORY::
No of Age changes (………) Date of enrollment Present DOB
(…………………………….)
Changed DOB(IFCHANGED)
CASTE DETAILS ::
AP SEVA Caste Certificate Number
Caste Sub - Caste
INCOME CERTIFICATE DETAILS ::
AP SEVA Income Certificate Annual Income
Number

ELIGIBILITY PARAMETERS
S.NO CATEGORY DETAILS
1 Family Income per month Rs……………..
2 Dry land --------------Acres
3 Wet land ---------------Acres
4 Electricity Consumption --------------Units
5 Property in Municipal area ------------ Sq. Ft
6 State /Central GOVT employee / pensioner Yes/ No ::
7 Four Wheeler Yes / No ::
8 Income Tax payee Yes / No ::
TO BE ENCLOSED :1.Aadhar Card 2. AP SEVA Caste Certificate 3. AP SEVA Income Certificate 4.Aadhar Update History

5. Bank Pass Book 6.Rice Card

Applicant Signature Volunteer Signature Signature of the DA/WEDS Signature of the WEA/WWDS