Conversion of White Card to Pink Card Conversion of White Card to Pink Card

Ration Card Member Addition (Birth) Application Form

Request Details
Ration Card No*:____________________________________
____________________________________

Member Addition Details

Member
Name

Mother Name

DOB
(dd/mm
/yyyy)

Gender

Age

Father Name

Spouse
Name

EID

UID

Informant Details
Applicant Name/ House Head Name*::______________________________________
Informant Name*:________________________________________________________
________________________________________________________
Informant Relation*:______________________________________________________
______________________________________________________
Mobile No*:____________________________________________________________
____________________________________________________________
Delivery Type*:


Manual
Proof Document*:
Affidavit
Birth Certificate
CGHS Card

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

Application Form*

2.

Proof Document*

3.

Photo*(JPG or JPEG format only)

Applicants Signature

Relation
with Head