CIDR/UID NO.

RECEIPTS NO..
PHOTO NO.

APPLICATION FOR
1. NAME
2
ANSHL BHARDLO AJ
FATHERIHUSBAND NAME: RATESH BHARDWAT
3
MOTHER NAME: PRITINA
4

5
MALE/FEMALE:_MALE
MARRIED/UNMARFIED: ONMARRIED
6. CASTE :
7. DATE OF BIRTH: (2| 12/20oh
8. MOBILE NO.: 86 3859o3
9. RATION CARD NO.
10. VILLAGE/CITY BAPoRA HOUSE NO. 223WARD NO.
TEHSIL BHIOANI DISTRICT BAIWANI
PIN CODE 12 7I|
11. B.P.LJA.P.L.

12. HALKA PATWARI NAME

2
3.
4.

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