Form 2 APPLICATION FOR ADDITION/DELETION IN THE CARD

Circle No
Registration No……………………….
Date of receipt………………………..
Date of calling………………………..
Form 2
APPLICATION FOR ADDITION/DELETION IN THE CARD
Warning:- It is an offence punishable with imprisonment and/or fine to make false statement or to suppress any
material information in the application.
1.
2.
3.
Name of the Food Card Holder………………………………………………………………………….
Present Address………………………………………………………………………………………….
Food card No…………………………FPS No…………………….Units………………Cereal……….
Regd. at Serial No……………….Sugar……….
4.
Purpose of application
5.
Sl.
No
.
Addition/deletion/conversion from minor to adult.
Particulars of the members to be added/deleted/converted from minor to adult.
Full Name
Father’s/Husband’s age
Date of arrival for Period of
Name
new comer/ date
stay for
of birth in case of addition
newly born child/
date of departure
in case of deletion
For
conversion
from minor
to major
(attach
documents
Date
of
birth &
present
age
Note:- Strike out the portion which is not applicable.
Declaration:- I solemnly declare that the above information given by me is correct. The persons for which
addition is applied for neither hold any Food Card in their own names nor their names are included in any other
Food Card in the National Capital Territory of Delhi.
Signature/T.I. of H.O.F.
Circle No.
Name of the Food Card Holder
COUNTERFOIL
Registration No.
Date of receipt
Date of calling
Signature of counter Clerk
(FOR OFFICE USE ONLY)
Addition/deletion of ………………………….adults…………………………..minors made/minors converted into
adults and units revised from………………..cereal……………………sugar to……………………………………
cereal…………………………..sugar.
Signature of F.S.O./Inspector of H.Qr.
Signature of counter clerk
Date:
Received Food Card No………………….
Date………………………………………..
Signature/T.I. of Card Holder
INSPECTOR’S PRE-VERIFICATION/POST-VERIFICATION REPORT
Visited on …………………….and contacted Shri………………………………..H.O.F./Other member of the
family/neighbour, holder of Food Card No…………………….Regd. with F.P.S. No……………………at Regn.
No……………………………………….
The above mentioned addition in the Food Card has been pre-verified/post verified and is found to be
correct/incorrect as per detail given below.
Signature of the Inspector with date
Full Name:…………………………
1.
2.
3.
Date of receipt by the Inspector for pre-verification/post-verification……………………………………...
Date of return by the Inspector after pre-verification/post-verification…………………………………….
Date of receipt by the Counter-Clerk after verification…………………………………………………….
Signature of Food & Supplies Officer
Signature of Counter Clerk with date
Circle No………………………….
Full Name…………………………