APPLICATION
FOR FAMILY IDENTITY CARD
ANDAMAN
AND NICOBAR ISLANDS
Serial No. of
the Register
1.
Full Name (In block letters)
.
2.
Fathers
/ Husband's Name
.
3.
Name of Head of Family
Identity Card No
..
4.
Sex
Age
Adults
.
Child
5.
House Address
.
6.
Occupation
.. Annual Income
8.
Persons for whom
Family Identity Cards are required :-
Name
Age
Relationship with
Occupation
Remarks
(BLOCK LETTERS)
Head of Family
1.
2.
3.
4.
5.
6.
7.
8. Existing Card No
..FPS.No
..
9.I Solemnly declare that to the best of my knowledge the above
information is correct.
Signature of thumb impression
of Applicant
Date:
1.
Signature of
Enumerator.
2.
Signature of
Panchayat Pradhan/Municipal Councillor/Village Captain
3.
Report of Enquiry
Inspector/Assistant Director(Civil Supplies)
4.
Cards prepared and
checked on.
Received Family Identity Cards/Nos.
Date
.19
Signature of
thumb impression
of Applicant
Counterfoil
Name of applicant
.S/o,W/o,D/o
Address
.
Date
19
.
Signature of Enumerator.