Swargadwar Seva Samiti, Puri Application Submit To General Yojana ANNEXURE-A Deceased Details Male Female Choose Decreased District: Puri Angul Baudh Balangir Bargarh Balesore Bhadrak Cuttack Deogarh Dhenkanal Ganjam Gajapati Jharsuguda Jajpur Jagatsinghapur Khordha Keonjhar Kalahandi Kandhamal Koraput Kendrapara Malkangiri Mayurbhanj Nabarangpur Nuapada Nayagarh Rayagada Sambalpur Subarnapur Sundargarh Choose a State: Odisha Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttarakhand Uttar Pradesh West Bengal Andaman and Nicobar Islands Chandigarh Dadra and Nagar Haveli and Daman & Diu The Government of NCT of Delhi Jammu & Kashmir Ladakh Lakshadweep Puducherry Choose Decreased ID Proof: AdharCard VoterIDCard PANCard DrivingLicenses Passport Attach ID proof of Decresed Person : Choose a death declaration: Hospital/DoctorDeathDeclaration Corporator/Sarpanch/WardmemberDeclaration MP/MLA/Govt.OfficialDeathDeclaration Asha/AnganwadiDidiDeathDeclaration Attach Death Declaration : Township Village Area Applicant Details Today Date: Choose Applicant District: Puri Angul Baudh Balangir Bargarh Balesore Bhadrak Cuttack Deogarh Dhenkanal Ganjam Gajapati Jharsuguda Jajpur Jagatsinghapur Khordha Keonjhar Kalahandi Kandhamal Koraput Kendrapara Malkangiri Mayurbhanj Nabarangpur Nuapada Nayagarh Rayagada Sambalpur Subarnapur Sundargarh Choose a State: Odisha Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttarakhand Uttar Pradesh West Bengal Andaman and Nicobar Islands Chandigarh Dadra and Nagar Haveli and Daman & Diu The Government of NCT of Delhi Jammu & Kashmir Ladakh Lakshadweep Puducherry Choose Applicant ID Proof: AdharCard VoterIDCard PANCard DrivingLicenses Passport Attach ID proof of Applicant : Reach Time: I undertake that, All Above Declaration are truth and correcte