Transcription of family membership certificate -Application Form
1 family memberApplicant Details AADHAAR Card Number *:_____Applicant Name * :_____Gender*: Male Female Date of BirthPermanent Address: Door No : _____ Locality / Land Mark : _____ District*:_____Village / Ward *:_____Present Address: Door No : _____ Locality / Land Mark : _____ State*:_____ DistrictVillage / Ward *:_____Mobile * : _____E-Mail: _____ Remarks :_____ Ration card NO :_____ Delivery TypeDeceased Details: Deceased Name* : _____ father/Husband Date of Death (DD/MM/YYYY)* : _____Reason for Death* : Accident Floods / Cyclones / Thunder Bolt Collapse of buildings/Bridges Ill healthOccupation*: State Government Services Cooli agriculture Labor Rickshaw Puller / Auto / Taxi / Lorry drivers/cleaners construction workers Working in factoriesRetired Employee Farmer Business ManAADHAAR Card Number: _____ Death place Aadhaar Enrolment Number: Format White to Pink Card family membership certificate -Application Form :_____ _____ Relation Name* _____Female Date of Birth* (DD/MM/YYYY): _____ Locality / Land Mark : _____ _____ Mandal*:_____ :_____ Pin Code : _____ _____ Locality / Land Mark : _____ _____ District*:_____ Mandal*:_____ :_____ Pin Code : _____ Phone :_____ Mail: _____ Remarks :_____ Ration card NO :_____ Delivery Type*: Manual Local post : _____ father/Husband Name * :_____.
2 _____ Floods / Cyclones / Thunder Bolt Fire Accident DrowningIll health General Death Suicide Missing MurderState Government Services Central Government Services Public sector under takings Rickshaw Puller / Auto / Taxi / Lorry drivers/cleaners Building Working in factories Fishing Other Occupations Handloom WorkerBusiness Man Pensioner _____ Death place *_____Number: Format (1234/12345/12345):_____ (DD/MM/YYYY): _____ _____ Locality / Land Mark : _____ _____ Locality / Land Mark : _____ :_____ Pin Code : _____ Phone :_____ Mail: _____ Remarks :_____ Non Local post :_____ Drowning Murder Public sector under takings Building Handloom Worker _____ _____ of the family Member* * Documents List: (NOTE: size of Upload Document should not exceed 3 All Upload Documents should be in PDF Format Only)1.
3 Application Form* 2. A notarized affidavit containing Name, Age and Relationship with Document (Ration card/ Voter ID Card/ Passport/ Passbook, Aadhar cards, etc.) indicating the relationship of the applicant with the deceased4. Death certificate /FIR* with Deceased* Maritial status (NOTE: size of Upload Document should not exceed 3 All Upload Documents should be in PDF Format Only)containing Name, Age and Relationship with deceased.* Document (Ration card/ Voter ID Card/ Passport/ Passbook, Aadhar cards, etc.) indicating the relationship of the applicant with the deceased* Applicant s Number(UID) * (NOTE: size of Upload Document should not exceed 3 All Upload Documents should be in PDF Format Only) Document (Ration card/ Voter ID Card/ Passport/ Passbook, Aadhar cards, etc.) indicating the Applicant s Signature
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