Senor Citizen ID Card Form
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Transcript of Senor Citizen ID Card Form
![Page 1: Senor Citizen ID Card Form](https://reader035.fdocuments.net/reader035/viewer/2022081806/5532ea9755034687698b4735/html5/thumbnails/1.jpg)
APPLICATION FORM FOR ISSUANCE OF SENIOR CITIZEN
IDENTITY CARD/ RENEWAL OF IDENTITY CARD.
1. Name .....................................................
2. Father’s/Husband’s Name .....................................................
3. Date of birth/Age .....................................................
4. Whether domicile of Haryana .....................................................
5. Permanent Address .....................................................
6. Whether belongs SC/ST/BC .....................................................
Ex-serviceman
7. Whether belongs to minority .....................................................
8. Whether your name appear in .....................................................
the BPL list of so then indicate
BPL No.
9. Whether getting Old Age .....................................................
Allowance/Handicapped Pension
Government ?
10. In case of renewal, furnish following information :-
a) Identity Card No. .....................................................
b) Date of issuance of I/card .....................................................
c) Date of expiry of the I/card .....................................................
d) Name of Issuing authority .....................................................
Place : HISAR Signature of the Applicant Date : Enclose :- following documents Contact No. .........................
1. copy of ration card Attested 2. Two Photo 3. Age proof Certificate Attested 4. copy of Voter Card Attested
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