Swargadwar Seva Samiti, Puri Application To Submit for Harischandra Yojana (According To Chief Minister Relief Fund,ANNEXURE-A) ANNEXURE-A Deceased Details Male Female Choose Deceased 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 Deceased State: Odisha Choose Deceased ID Proof: AdharCard VoterIDCard PANCard DrivingLicenses Passport Attach ID proof of Decresed Person : Choose a death declaration: Hospital/DoctorDeathDeclaration Corporator/Sarapancha/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 Applicant State: Odisha Choose Applicant ID Proof: AdharCard VoterIDCard PANCard DrivingLicenses Passport Attach ID proof of Applicant : Reach Time: 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 undertake that, All Above Declaration are truth and correcte