7/26/2019 Simplified Proforma Dated 26.5.2016 (1)

1/9

Simplified Proforma for Services under RTS Act. Service No. 96 (a) and (b) ckow BzH ;H;H^I

OAP (pYkgk g?BPB)Photo of

Applicant

fpB?eko dh

c'N'

1. Name of the Service/ ;/tk dk yso Rural / U rban Area

2.

Name of Applicant/fpB?eko dk Bkw

3. Name of Father/ fgsk dk Bkw

4. Name of Husdband/ gsh dk Bkw

5.

Age of Applicant/ fpB?eko dh T[wo

6.

Male/ Female/g[oP$fJ;soh

7.

Permanent Address/gZek gsk

8.

Correspondence Address/gZso ftjko bJh gsk

9.

Phone No./Mobile No.

c'B BzH$ wpkfJb BzH

10.

Correspondence e-mail/

JhHw/b nkJhHvhH

11.

Aadhaar card No. (Attach Copy)

12.

BPL No./rohph oyk sA j/mK dh ;uh dk BzH (ekgh

BZEh)

13. SC/BC/ GEN

n;H;hH$ phH;hH$ iBob

14. Husband/Wife alive or not?

eh gsh$gsBh fidk j?