Price: ` 1

Ration Card Modifications Application Form

Request Details
Ration Card No*:

Please check the below modifications if required

Address Change
Member Details Modifications

In Case of Present Address Change

House No. to be changed*: Landmark/Locality/Colony to be changed*:
changed

District to be changed*: Mandal to be changed*:

Ward/Village to be changed*: Pin code to be changed *:

Wish to Change F.P Shop No*:
YES
NO F.P Shop No. to be changed*(If Yes):

Proof Document of Present Address Change

Change*:
Driving License
Rental Agreement
Electricity Bill

Bank Pass book
LPG Receipt
Telephone Bill

Aadhar Card
Affidavit
Voter Id
Passport

In Case of Member Details Modifications

Name DOB Gender Father/Husband EID UID Relation with Reason for
(DD/MM/YYYY) Name Head Modifications

Informant Details
Informant Name*: Relation*: Mobile No*:

Delivery Type*:
Manual

Reason for House Hold Head Modifications*(Max 200 Characters):

Documents List
(NOTE: 1. All Upload Documents should be in PDF Format only 2. Each file should not exceed 50KB)

1. Application Form*
2. Proof for Address/Card Transfer *
3. Proof for Member Modifications
Modifications*

Applicant’s Signature