ANNEXURE "H" DECLARATION

(See clause 7(1) of G.D.D Controlled Commodities (Regulation Of Distribution Order 1966)


Taluka *  
Village *  
FPS Name *
Email ID  
Old Ration Card No.  
Ward/Wado  
Panchayat/Municipality  
Mobile No. *   
House No. *  
 
Aadhaar No/Enrollment ID  
Name of the Head of the Family (in full) *  
 
Total monthly income of all members of the family (Rs.) *  
 
Whether the house is electrified or not *
Bank *
Branch
Bank Account Number *  
 
IFSC Code
Gas Connection Status * Select Status K.Oil Eligibility

Member Details in the Family
 NAME OF THE PERSONS IN THE FAMILY INCLUDING HEAD OF THE FAMILY RELATION WITH THE HEAD OF THE FAMILY DATE OF BIRTH GENDER EPIC NO. AADHAAR/ENROLLMENT ID
* * (dd/mm/yyyy) * *
   
 



I do solemnly declare that :-

(i) I or any of the above mentioned member of the family do not possess ration card in my/their names nor my name/their name/names is/are included

in the ration card elsewhere.

(ii) The above statement is complete and true to the best of my knowledge and belief and I undertake to hold myself responsible if any part or whole

thereof is found to be false.

Upload Election Card copy *
Format: PDF Max Size:40Kb

 
Upload Aadhaar Card copy *
Format: PDF Max Size:40Kb

 
Place *  
 
Captcha Image Visual verification 

* Please mention H.No. given by Panchayat/Municipality or name of the Building/Flat No.
* Mention correct name and ages as per Birth Certificate.
* The declaration should be signed by the Head of the Family only.







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