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Cheyutha Pension Verification Format

The document is a Household Verification Format used for collecting and verifying family details and household parameters for eligibility in food security and pension schemes. It includes sections for family member information, verification parameters, and declarations by verification officers. The document also requires signatures from the verification officer, Tahsildar, and MPDO to confirm the findings.

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Sai Krishna
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242 views1 page

Cheyutha Pension Verification Format

The document is a Household Verification Format used for collecting and verifying family details and household parameters for eligibility in food security and pension schemes. It includes sections for family member information, verification parameters, and declarations by verification officers. The document also requires signatures from the verification officer, Tahsildar, and MPDO to confirm the findings.

Uploaded by

Sai Krishna
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

SK Survey Number:

Household Verification Format

Name of the Mandal Name of the Gram


Panchayat
Name of the Habitation Social Category (SC /
ST / BC / OC )
Name of the Father / Gas Connection (Y/N)
Mother / Husband

Family Details of Family Members (Head of the Household should be entered first)
Sl Name of the Family Relationshi Sex Land as 1B Artisan Status of Aadhar Card Number Field
No member (with surname) p with register / Status Employment Status
(age in brackets) Head of Field / Pensioner (Y/N)
HH Verification Details
1
2
3
4
5
6

Verification Parameters of the household to be verified:


Sl Verification Parameters Data as per SK Survey As per field Verification
No
1 Type of House (thatched/ Plastic roof/Tiled/RCC)
2 Total Land Holding (Acres): Wet/ID:_____; Dry_____ Wet/ID_____; Dry______
3 4 wheeler owners
4 IT Assessed
5 Freedom fighters pensioners
6 Number of PWD members in the household
7 Nomadic Household (Y/N)

Family Status: If the members in the family are living together and were deliberately split for the purpose of the survey, then indicate the
survey format numbers of artificial households to be combined with this household:

Verification Officer Remarks:

Declaration:
It is certified that, I have personally visited the above household and verified all the above details. I certify that the above information
is true recommend the following:
1. Eligible for Antyodaya Food Security Card Name of Beneficiary eligible for Old Widow Disa Toddy Weaver
2. Eligible for Food Security Card pensions Age bled Tapper
3. Ineligible for Food security Card
4. No one eligible for Pensions

Name & Signature of the Verification Officer:


Date of Visit:
It is certified that, after scrutinizing the verification It is certified that, after scrutinizing the verification parameters with the
parameters with the eligibility criteria, I confirm the eligibility criteria, I confirm the following:
following: Name of the Beneficiary Type of Pension
1. Issue Antyodaya Food Security Card
2. Issue Food Security Card
3. Ineligible for Food Security

NO ONE ELIGIBLE

Name & Signature of the Tahsildar: Name & Signature of the MPDO:
Date: Date:

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