Price: `1

Ration Card Data Corrections Application Form

Applicant Details:Applicant Name
Father Name
Door No
District
Village
Ration Card No

: ___________________________________Date of Birth
: ___________________________________Mother Name
: ___________________________________Street Name
: ___________________________________Mand
___________________________________Mandal
: ___________________________________
___________________________________Mobile No
: ___________________________________

: _____________________________
_________________________
: _____________________________
_________________________
: _____________________________
______________________
: _________________________
____________________
: _____________________________
______________________

Corrections Required in House Hold Card

Card:Head of House Hold Name: _____________
_____________________________Father/Husband Name
Date of Birth
: _____________________________
_____________________________Occupation
House/Door Number
: _____________________________Street Name/Number
Colony Name
: _____________________________ Village/Ward
Mandal / Municipality
: _____________________________ District

: ______________________________
: ______________________________
_____________
: _____________________________
_________________________
: ______________________________
: ______________________________
_____________

Corrections Required in Family Member Details

Details:S.No
1
2
3
4
5
6
7
8
9
10
11

Name

Relation With Head of House Hold

Date of Birth

Proof Documents List (Any one of the below should be attached)

attached):
Bank
Bank Pass Book

Certificate
Certificate Issued by Educational Dept

Driving License

Employee ID card

Other Govt Benefit Proof Documents

Telephone Bill

Copy of Ration Card

Copy of Electricity Bill

LPG Gas Connection Voucher

Birth Certificate

Copy of Arogyasri Card

Educational Certificate

Municipal Tax Receipt

Passport

Transfer Orders (ETC)

Copy of Voter Card

Copy of Pan Card

Rs.10/- Bond Affidavit Duly Attested

Proof Document Number: ________________________

____________________________________________________

Declaration:I hereby declare that the above-mentioned

mentioned information is correct up to my knowledge and I bear the responsibility
for the correctness of the above-mentioned.
mentioned.
Date:
Place:

Applicants Signature