General

ANNEXURE-A

Swargadwar Seva Samiti, Puri Application Submit To General Yojana

Deceased Details

Male Female

Choose Decreased District: Choose a State:

Choose Decreased ID Proof: Attach ID proof of Decresed Person :

Choose a death declaration:
Attach Death Declaration :

Township Village Area

Applicant Details Today Date:

Choose Applicant District: Choose a State: Choose Applicant ID Proof: Attach ID proof of Applicant :
Reach Time:
I undertake that, All Above Declaration are truth and correcte