RATION CARD

�கவ� மா�ற� / ெபய� ந��க� / ெபய� ேச��த� இதர தி��த�க��கான வ��ண�ப ப�வ�

APPLICATION FORM FOR CHANGE OF ADDRESS / NAME DELETION INCLUSION &OTHER CHANGE

அ�ைட எ� :

Card No:

For Office Use Only

கைட �றிய�� எ� :

Shop Code No :

SCI (Zone) SCO (Zone) / SCO (Dist) SCI (Dist) SCO(State) Change of Address

அ���ந� :

From:

(���ப அ�ைடய�� கைடசியாக தி��த� ெச�ய�ப�ட வ�பர�) (Latest Address appearing in family card should mentioned):

ெப�ந� :

உதவ� ஆைணயாள�

உ.ெபா.வ.ம.�.பா.�ைற,

To: Assistant Commissioner, Civil Supplies and Consumer Protection Department, .

அ�யா / Sir ,

ெபா��: �கவ� மா�ற� / ெபய� ந��க� / ெபய� ேச��த� இதர மா�ற�க�

Sub : Change of Address / Name Deletion / Name inclusion / Other Changes ******

என� ���ப அ�ைடய�� ப��வ�� மா�ற�க� / தி��த�க� பதி� ெச�� தர ேகா�கிேற�

I request you to make the following changes / correction in my Family Card

�கவ� மா�ற� / Change Of Address:

பைழய �கவ� / Old Address :

தி��த� ெச�ய ேவ��ய �கவ� / New Address to noted:

�திய இ��ப�ட�தி�கான ஆதார� / Address Proof for New Residence :

ெபய� ந��க� / Deletion of Name :

ெபய� ந��க� ெச�ய ேவ��ய நப�/வய� / உற��ைற

Name of the person to be deleted / Age / Relationship: 1. 2. 3. 4.

ெபய� ந��க� ெச�வத�கான காரண� / Reason for deleting the Name:

ெபய� ேச��த� / Inclusion Of Name :

ேச��க�ப�� நப�� ெபய� / வய� / உற��ைற / Name , Age

, Relationship of Persons to be included :

1. 2. 3. 4.

ேச��பத�கான ஆதார�(ெபய� ந��க� சா��/ப�ற�� சா��) :

Proof for Inclusion ( Name Deletion Certificate / Birth Certificate ) :

இதர மா�ற�க� – ெபய� தி��த� / எ�வா� தி��த�:

Other Changes / Name / Age / LPG Cylinder Correction :

தி��த�தி�� இைண�க�ப�ட ஆதார வ�வர�:

Supporting Documents enclosed for Correction: