Ration Card Data Corrections Application Form
Applicant Details:-
Applicant Name : ___________________________________Date of Birth : _____________________________
Father Name : ___________________________________Mother Name : _____________________________
Door No : ___________________________________Street Name : _____________________________
District : ___________________________________Mandal : _____________________________
Village : ___________________________________Mobile No : _____________________________
Ration Card No : ___________________________________
Corrections Required in House Hold 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:-
[Link] Name Relation With Head of House Hold Date of Birth
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Proof Documents List (Any one of the below should be attached):-
Bank Pass Book Birth Certificate
Certificate Issued by Educational Dept Copy of Arogyasri Card
Driving License Educational Certificate
Employee ID card Municipal Tax Receipt
Other Govt Benefit Proof Documents Passport
Telephone Bill Transfer Orders (ETC)
Copy of Ration Card Copy of Voter Card
Copy of Electricity Bill Copy of Pan Card
LPG Gas Connection Voucher Rs.10/- Bond Affidavit Duly Attested
Proof Document Number: ____________________________________________________
Declaration:-
I hereby declare that the above-mentioned information is correct up to my knowledge and I bear the responsibility
for the correctness of the above-mentioned.
Date:
Place: Applicant’s Signature
