Diphu Name of LAC:- 19 Diphu (ST) LAC Name of District :- Karbi Anglong Name of Sub –Division:- Name of village/municipal /Town Ward:- Ward No. 2 Targeted Population……………………………………… No.& Name of Gaon Panchayat ………………………………………… Name of Development Block………………………………………………………………….. ….. Name of Revenue Circle:- Diphu . Name of GPSS/WCCS …………………………………………………………………………………… Name of nearest Fair price Shop Dealer………………………………………………………Name of GPSS/WCCS Type of F.C.I As per recent voter list of Photograph of Performa- Card no. of Annual Card (for BPL/ Occupation of the Total assembly election C & check existing FIC Women applicant family Name of women applicant number of Father/ Husband Name Head of the family Sl No. list Holder or MMASY/ (under NFSO) family (size 3.5 cm)X 2.5 income registration mention new as per Performa- C members PS No. SL No. House No. declared APL Card Cm) no. applicant Holder only) Kalpana Sah Pradip Saha 20000 185 434 157 164 NEW APL Housewife 4 Anita Mazumdar Karnajit Mazumdar 5000 181 496 168 165 NEW APL Housewife 3 Soma Bhowal Prafulla Ch. Bhowal NIL 463 158 166 NEW APL 3 181 Housewife
Name of LAC:- 19 Diphu (ST) LAC Name of District :- Karbi Anglong Name of Sub –Division:- Diphu Name of village/municipal /Town Ward:- Ward No. 2 Targeted Population……………………………………… No.& Name of Gaon Panchayat ………………………………………… Name of Development Block………………………………………………………………….. ….. Name of Revenue Circle:- Diphu . Name of GPSS/WCCS …………………………………………………………………………………… Name of nearest Fair price Shop Dealer………………………………………………………Name of GPSS/WCCS Sl No. Performa- C & check list registration no. Card no. of existing FIC Holder or mention new applicant Type of F.C.I Card (for BPL/ MMASY/ APL Card Holder only) Name of women applicant (under NFSO) Father/ Husband Name Occupation of the Head of the family as per Performa- C Annual family income declared Total number of family members As per recent voter list of assembly election Photograph of Women applicant (size 3.5 cm)X 2.5 Cm) PS No. SL No. House No. 164 NEW APL Kalpana Sah Pradip Saha Housewife 20000 4 185 434 157 165 NEW APL Anita Mazumdar Karnajit Mazumdar Housewife 5000 3 181 496 168 166 NEW APL Soma Bhowal Prafulla Ch. Bhowal Housewife NIL 3 181 463 158
WARDWISE_UNDER_NFSO.docx