Application Form for Indra Gandhi National Old Age Pension Scheme

Application form for Indira Gandhi National Old age Pension Scheme

To The Mayor Past your Asansol Municipal Corporation passport Size Asansol photograph here

Sir, I am a resident of ward No______under this corporation area. I am an old person. My family is included in the BPL list. My detail information is given below.

I will be obliged to you if you approved my name for this pension. The attested copy of the related age proof other documents are attached here with.

Detail Information

1. Name of the Municipal Corporation: ……………………………………………………. 2. Ward No………………………………………………………………………………..…. 3. Name of the Beneficiary :………………………………………………………………….. 4. Name of the head of the family……………………………………….…………………… 5. Parents / Husband Name ………………………………………………………………….. 6. Date of Birth…………………………………………………………..……………..…… 7. Address:………………………………………………………….House No……………… Street/ Para / Slum ………………………………………………………………………… Pincode ………… ………… 8. Nominee Name ………………………………………………..………………………….. 9. Are you belongs to : ( Put atick which is applicable) Schedule Cast Schedule Tribe OBC Other General 10.Whether are you belongs to the Minority ? 11.BPL Sl. No……………………BPL ID No……...………Total Survey Score………….… 12.Ration Card/ EPIC Card No……………………… 13.Annual Income………………… 14.Gender: Male Female 15. Age as on 01-01-2010…………………………..

Councillor , Ward No…………. Signature / Thumb Impression of the Applicant

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