Form No.1

Application form for New Ration Card

( Especially for Municipal / Notified areas )

Fair Price Shop No……..	Present address of …………………………… the applicant…………………………………. …………………………………………………					Only for office use
Present Ration Card No.						No. of members eligible to be included in new Ration Card.		Signature of the Inquiry Officer	Signature of the Supervisory Officer.
Name of the Head of the family with other members.	Whether they have ration Cards, Yes or No.	If not, what is the reasons behind it	Ralationship with the Head of the family.	Age	Adult		Minor

1) Name of Head of the Family &

Father’s/Husband’s name

………………………………….

…………………………………

2) Others :-

i)

ii)

iii)

iv)

vi)

vii)

viii)

…………………………………………………………………………………………………….

N.B. Present Ration Card is to be appended with it Applicant’s signature/thump impression

Counter foil.

Fair price shop No.	Ration Card No.	Name of the Head of family & Father’s/Husbands name.	No.of family members			Signature of the Inquiry officer.
			Adult	Half Adult	Total