APPLICATION FORM FOR OLD AGE PENSION UNDER NSAP
PART –1
DISTRICT MANDAL:
WARD &H.NO LOCALITY:
1 FULL .NAME
2 NAME OF THE FATHER/HUSBAND’S
3. FULL RESIDENTIAL ADDRESS:
4. WHETHER SC/ST/BC
5.WHETHER LANDLESS WOMEN
OR PHYSICALLY HANDICAPPED
6.AGE ON THE DATE OF THE APPLI-
CATION (MORE THAN 6(SIX) MONTHS
MAY BE COUNTED AS FULL YEAR)
7 I SOLEMNLY AFFIRM THAT
A. I AM A DESTITUTE AND HAVE MEAGRE OR NO SOURCE OF INCOME OF MY OWN OR FAMILY OR SUPPORT FROM FAMILY MEMBERS OR FROM OTHER SOURCE.
B. I HAVE/HAVE NOT APPLIED PREVIOUSLY FOR GRANT OF OLD AGE PENSION UNDER NSAP.
C. I AM RESIDENT OF ------- DISTRICT WHERE I HAVE BEEN RESIDING DURING THE 3 YEARS IMMEDIATELY PRECEEDING THE DATE OF APPLICATION.
D. I DECLARE THAT THE INFORMATION FURNISHED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
PLACE:
DATE:
SIGNATURE OR THUMB IMPRESSION OF THE APPLICANT.
(This application needs to be submitted to the Mandal Parishad Development officer after obtaining necessary documentary evidence from the MRO)
PART –1
DISTRICT MANDAL:
WARD &H.NO LOCALITY:
1 FULL .NAME
2 NAME OF THE FATHER/HUSBAND’S
3. FULL RESIDENTIAL ADDRESS:
4. WHETHER SC/ST/BC
5.WHETHER LANDLESS WOMEN
OR PHYSICALLY HANDICAPPED
6.AGE ON THE DATE OF THE APPLI-
CATION (MORE THAN 6(SIX) MONTHS
MAY BE COUNTED AS FULL YEAR)
7 I SOLEMNLY AFFIRM THAT
A. I AM A DESTITUTE AND HAVE MEAGRE OR NO SOURCE OF INCOME OF MY OWN OR FAMILY OR SUPPORT FROM FAMILY MEMBERS OR FROM OTHER SOURCE.
B. I HAVE/HAVE NOT APPLIED PREVIOUSLY FOR GRANT OF OLD AGE PENSION UNDER NSAP.
C. I AM RESIDENT OF ------- DISTRICT WHERE I HAVE BEEN RESIDING DURING THE 3 YEARS IMMEDIATELY PRECEEDING THE DATE OF APPLICATION.
D. I DECLARE THAT THE INFORMATION FURNISHED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
PLACE:
DATE:
SIGNATURE OR THUMB IMPRESSION OF THE APPLICANT.
(This application needs to be submitted to the Mandal Parishad Development officer after obtaining necessary documentary evidence from the MRO)
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