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Change of Ration Shop Application Form

This document is an application form for changing the designated Fair Price Shop (FPS) for receiving rations. It contains three parts for different circumstances: Part I is for shifting the entire family to a new FPS. Part II is for shifting an individual family member due to marriage. Part III is for shifting multiple family members to a new address. The applicant provides their name, ration card number, relationship to head of family, and desired new FPS. Once submitted, the authority signs to acknowledge receiving the application.

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430 views2 pages

Change of Ration Shop Application Form

This document is an application form for changing the designated Fair Price Shop (FPS) for receiving rations. It contains three parts for different circumstances: Part I is for shifting the entire family to a new FPS. Part II is for shifting an individual family member due to marriage. Part III is for shifting multiple family members to a new address. The applicant provides their name, ration card number, relationship to head of family, and desired new FPS. Once submitted, the authority signs to acknowledge receiving the application.

Uploaded by

Sk Mon
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Form: VI-R (Application form for Change of Ration Shop (FPS) in respect of families already Included in NFSA/RKSY eligible

family List)
(Please fill PART-I or PART-II or PART-III whichever is applicable)

To
The Inspector Food & Supplies,
……………..…………………. Block, District ……………………..……………………

Sir,
The names of the members, as noted here-in-under has appeared in the Rajya Khadya Suraksha Yojana (RKSY) / National Food Security Act (NFSA) List. I / We apply for change of the Fair Price Shop (FPS) as recorded
in the Ration Card.

Block - Gram Panchayet – Enumaration Block No.-


Village Samsad - Village - Mouza – Mobile no. (of any family member) -

PART-I : FPS shifting for all members of family

Name of the beneficiary Card no. Type of Card Father’s/Husband’s name Name of the Head of the Mention the name & no. of Mention the name and no. Reason for change of
(AAY/PHH/ family Ration Shop as recorded in of the Dealer of the Ration Ration Shop
SPHH/ the Ration Card Shop of your Choice /
RKSY-I/ Preference
RKSY-II )

OR
PART-II : Change of FPS due to shifting of a member from one family to another family due to marriage etc.

Name of the applicant Ration Card no. of Type of Card Ration Card no. of Head of Relationship of the
the applicant (AAY/PHH/ the Family where the applicant with of Head of
SPHH/ applicant has been shifted the Family where shifting
RKSY-I/ is requested
RKSY-II )

OR

PART-III : Change of FPS for shifting more than one member to a new address

Name of the applicant Ration Card no. of Type of Card Ration Card no. of Head of Name of FPS where
the applicant (AAY/PHH/ the Family * shifting is applied for
SPHH/
RKSY-I/
RKSY-II )

*Please write “Head” against Head of the Family.

____________________
Signature of Applicant

-----------------------------------------------------------------------Return this portion to the Applicant--------------------------------------------------------------------------------------------------------------


The application form VI-R (for Change of Ration Shop) in respect of families already Included in NFSA/RKSY eligible family List ) has been received from Shri / Smt……… …………………………
………………………………., Address…………………………………………, Village. ………………….

__________________________
Signature of Authority (with Seal)

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