Harischandra

ANNEXURE-A

	Swargadwar Seva Samiti, Puri Help For Harischandra Yojana, Application Submit in Puri Swargadwar (Chief Minister Relief Fund ANNEXURE-A ACCORDING)
Death Person Details

Male Female

Choose a District: Choose a State:

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

Choose any death declaration:
Attach Death Declaration :

Township Village Area

Applicant Details

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Declaration:
We have no Four Wheeler in our Family.
In our Family No one Govt. Service Holder.
In our Family No one Govt. Pension Holder.
In our Family Total Land Not More than 5 Acers.
In our Family No one Income Tax Payer
I Read all Above Declaration.All Decaration are truth For my Family.
All Declaration Are true