Member Surrender under National Food Security Act (NFSA)
Address Details
Ration Card & FPS Details
Details of Family Members of Applicant
Other Info
RC No
Form No
OTP
Old Residential Address
District
*
Select District
Block/ULB(City)
*
Select Block
GP/Ward No
*
Select GP/Ward
Village/Area
*
Select Village/Area
Plot No/Qtr No(for ULBs) :
*
Pincode :
New Present Residential Address
District
*
Select District
Block/ULB(city)
*
Select Block
GP/Ward No
*
Select GP/Ward
Village/Area
*
Select Village/Area
Plot No/Qtr No(for ULBs) :
*
Pincode :
New Permanent Residential Address
Click If Permanent Residential Address is same as Present Address
State
*
Select State
District
*
Select District
Block/ULB(City)
*
Select Block
GP/Ward No
*
Select GP/Ward
Village/Area
*
Select Village/Area
Plot No/Qtr No(for ULBs) :
*
Pincode :
Duration of Stay in the Present Address
Year
*
Month
*
RC Type
*
--Select--
AAY
APL
BPL
RC No
*
Please provide FPS details from where you are taking PDS items or want to take if you dont have RC
Rice
FPS Name
*
--Select--
FPS Code
*
Wheat
FPS Name
*
--Select--
FPS Code
*
SK Oil
FPS Name
*
--Select--
FPS Code
*
Which Combination of food grains do you want in PDS(5 kg per individual per month)
*
--Select--
1 Kg Rice & 4 Kg Wheat
5 Kg Wheat
5 Kg Rice
2 Kg Rice & 3 Kg Wheat
3 Kg Rice & 2 Kg Wheat
4 Kg Rice & 1 Kg Wheat
If you want to change your FPS, please give the code of proposed FPS
*
--Select--
Sl No.
Full Name
Gender
Date of Birth
Relationship with eldest lady of the family
EPIC No
Aadhar No
Aadhar Enrollment No
Father Name
Spouse Name
Special Case(If Any)
Distribution Company
-Select-
Electrical Division
-Select-
Electricity Consumer No
Electricity Connection Owner
-Select-
Oil Company
-Select-
LPG Distributor
-Select-
LPG Consumer No
LPG Connection Owner
-Select-
Proof of Residence
-Select-
Proof of Identity
-Select-
Mobile No
Name of Mobile Owner
-Select-
Auto Inclusion Criteria
-Select-
Auto Inclusion Criteria Proof
-Select-
AI Member
-Select-
Bank Name
-Select-
Bank IFSC Code
-Select-
A/C No
A/C Holder Name
-Select-
