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By yessuresh Aug 01, 2012 336 Words
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ಸುವರ್ಣ ಕರ್ನಾಟಕ |
ಆಹಾರ,ನಾಗರಿಕ ಸರಬರಾಜು ಮತ್ತು ಗ್ರಾಹಕರ ವ್ಯವಹಾರಗಳ ಇಲಾಖೆ | ಹೊಸ ಪಡಿತರ ಚೀಟಿಗಾಗಿ ಅರ್ಜಿ |

Receipt No | 314422 | Receipt Date | 26/11/2011 | |
Place of Residence | Urban/IRA | |
District | BANGALORE | Taluk | BANGALORE SOUTH(IRA) | | City | BANGALORE IRA SOUTH | Ward No | 59 |
Card Type Applying For | Above Poverty Line |
Do you have Electricity Connection? | Yes |
District / Taluk /ESCOM Circle Code | BANGALORE / / |
Location Code | 1120301 | R R No | 1SH19160 |
If you share electricity bill with another family, then your average monthly share in rupees | 0 |

Name of the Applicant | G S NAGARAJA |
Residence Address
PIN | No 87/A, 31st A Cross, Yediyur, Jayanagar 7th Block, Bangalore 560082 | Office Address
0 |
Landmark | OPP CANARA BANK | Since how many years you are residing in the address? | 22.00 | | LandLine Phone No | 0 | Mobile No | 9902977412 |
Date of Birth (dd/mm/yyyy) | 09/04/1947 | Year of Birth (yyyy) | 1947 | Gender | Male | Aadhar No | |
E - mail | | Employment | RETIRED |
Residence Type | Own | | |
Marital Status | Married |
Do you stay with your Family? | Yes |


Other Details |
Total Income of the Family (in Rs.) | 15000 | Income Tax Pan Card No | | LPG connection is available? | Yes | Do you need LPGConnection? | No | LPG Details |
Company| Distributor| Consumer No| Consumer Name|
IOC| D K AGENCIES| 22270| Nagaraja G S|
Reasons to Apply for Ration Card | Non Computerised Ration Card | Remarks | |

ಘೋಷಣೆ |
ನಾನು ಈ ಮೂಲಕ ಘೋಷಿಸುವುದೇನೆಂದರೆ | ಅ)ನನ್ನ ಹೆಸರಿನಲ್ಲಾಗಲೀ ಅಥವಾ ನನ್ನ ಕುಟುಂಬದ ಯಾವುದೇ ಸದಸ್ಯರ ಹೆಸರಿನಲ್ಲಾಗಲೀ ಮೇಲಿನ ವಿಳಾಸದಲ್ಲಾಗಲೀ ಅಥವಾ ಬೇರಾವುದೇ ವಿಳಾಸದಲ್ಲಾಗಲೀ ಪಡಿತರ ಚೀಟಿ ಪಡೆದಿರುವುದಿಲ್ಲ. ಈಗಿನ ವಿಳಾಸದಲ್ಲಿ  22.00  ವರ್ಷದಿಂದ ವಾಸವಾಗಿರುತ್ತೇನೆ. | ಆ)ನನ್ನ ಕುಟುಂಬದ ಯಾವುದೇ ಸದಸ್ಯರ ಹೆಸರುಗಳು ಬೇರಾವುದೇ ಪಡಿತರ ಚೀಟಿಯಲ್ಲಿ ಯಾವುದೇ ರೂಪದಲ್ಲಿ ಸೇರಿರುವುದಿಲ್ಲ. | ಇ)ಎಲ್ಲಾ ಮೂಲಗಳಿಂದ ನನ್ನ ಕುಟುಂಬದ ಒಟ್ಟು ವಾರ್ಷಿಕ ಆದಾಯ ರೂ 15000 ಇರುತ್ತದೆ ಎಂದು ಪ್ರಮಾಣೀಕರಿಸುತ್ತೇನೆ. | ಈ)ಈ ಅರ್ಜಿಯಲ್ಲಿ ನೀಡಿರುವ ಮಾಹಿತಿಯು ನನಗೆ ತಿಳಿದ ಮಟ್ಟಿಗೆ ಸರಿಯಾಗಿದೆ ಮತ್ತು ಸತ್ಯವಾಗಿದೆ. | ಉ)ನಾನು ಮೇಲ್ಕಂಡಂತೆ ನೀಡಿರುವ ಮಾಹಿತಿಯು ತಪ್ಪು ಎಂದು ಕಂಡು ಬಂದಲ್ಲಿ ಅಥವಾ ತಪ್ಪು ಮಾಹಿತಿ ನೀಡಿ ಪಡಿತರ ಚೀಟಿ ಪಡೆದಲ್ಲಿ ಸರ್ಕಾರದ ಆದೇಶ ಸಂಖ್ಯೆ ಎಫ್.ಎಫ್.ಡಿ.32 ಎಒಎಮ್77 ದಿ 23.09.1977 ಹಾಗೂ ಭಾರತ ದಂಡ ಸಂಹಿತೆ ಅಡಿಯಲ್ಲಿ ನನ್ನ ವಿರುದ್ದ ಕ್ರಮ ಕೈಗೊಳ್ಳಬಹುದೆಂದು ಒಪ್ಪಿರುತ್ತೇನೆ. | ದಿನಾಂಕ : | 26/11/2011 | |

ಸ್ಥಳ : | BANGALORE IRA SOUTH | ಅರ್ಜಿದಾರರ ಸಹಿ |
| | |

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