గ్రామ – వార్డు సచివాలయము

ఆంధ్రప్రదేశ్ ప్రభుత్వం

Family Membership Certificate Application

Applicant Name :
Applicant Aadhar :
Father/ Husband Name :
Mobile Number: Date Of Birth : Sex : Male/ Female
Permanent Address :
District : Mandal :
Village : Street Name :
Pin Code : Cluster Number :
Deceased Details :
Deceased Name : Date Of Death :
Father/ Husband Name : Death Place :
Reason For Death : Accident Floods/ Cyclones/ Thunder Bolts
Fire Accident Collapse Of Buildings/ Bridges
Drowning Ill Health Missing
General Death Suicide Murder
Occupation :
Deceased Person Aadhar :

Name Of The Family Age Sex Relation With Marital Status Aadhar Number
Members Deceased

Documents To Be Attached :
1) Application
2) Notary
3) Family Members Aadhar, Ration Cards
4) Deseased Person Death Certificate