The land of the Dancing Deer

 

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FORM
FORM N.O.A.P …I
Application Form for Old Age Pension
I (To be filled up by the applicant)

          District :-                                   District/Municipality /Village/Panchayat/Mohilla/Ward/House No.

 

1. Shri/Smt :- ………………………………………………….. 
2. Name of Father’s or Husband:-
3. Full Address:-
4. Categories:- SC/ST/Woman/Landless/Widow/General.
5. Age on the date of the applicant :-
6. Identification mark of the applicant :-
7. I solemnly affirm that :-
1. I do not have any family income of Rs. 5000/- per annum or above.
2. I have/have not applied previously for grant of Old Age pension under NSAP.
3. I am a resident of ………………………………………………….
    (District/State) where I have been residing during the three years 
    immediately preceding the date of this application.
4. I declare that the information furnished in this application is true and
    correct to the best of my knowledge and belief .


Place :-                                                                          Signature of Thump impression
Date :-                                                                                     of the applicant

II (To be filled up by the enquiry team)
(Results of preliminary Enquiry by the Village Panchayat)


1. Age (65 years or above) :-
2. Income/Destination :-
3. Category, Domicile :-
4. Whether applying FOR the first time if not, the decision on the 
    last application:-
5. Whether the application belong under the proverty line:-
6. Recommendation :-
Date :- Signature of the Verifying person
Municipal Councillor/Village Authority/
Panchayat/PLC/AnganwandWorkers/VLWS.

 

Note :- This application should be sent with full particulars to the B.D.O/C.D.P.O, ICDS Project Concerned.



RECOMMENDATION OF THE B.D.O/C.D.P.O ICDS PROJECT



Date:-                                                           Signature of B.D.O/C.D.P.O, ICDS Project
                                                                            Countersigned by S.D.O concerned.