DECLARATION FORM

Card No

: 365370743511

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 263593328548

Name of Head of Household

: P Vijaya

Father/Husband Name

:-

Address

: 4-1-114,ATTAPUR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

P Vijaya

263593328548

Pasham Bal Reddy

283509247785

P Shashikanth Reddy

452237076434

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743533

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 335297866936

Name of Head of Household

: Anugula Yadamma

Father/Husband Name

:-

Address

: 4-4-170,ATTAPUR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Anugula Yadamma

UID

Photo

335297866936

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743538

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 860619372671

Name of Head of Household

: K Yadamma

Father/Husband Name

:-

Address

: 4-2-125,4-2-125, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

K Yadamma

UID

Photo

860619372671

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743557

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 691311417178

Name of Head of Household

: Qasim Bee

Father/Husband Name

:-

Address

Mandal

Family Members Details

SNo

Name

UID

Photo

Qasim Bee

691311417178

: 4-3-119/5/A,4-3-119/5/A,
Attapur, Attapur, Ward-1(V)

Shaik Nayeem Banu

796923330703

: CIRCLEIII(SAROORNAGAR)

Shaik Naaziya Begum

749351877267

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 30205
CARD HOLDER

1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743573

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 414600220915

Name of Head of Household

: Devamainolu Lakshmamma

Father/Husband Name

:-

Address

: 4-3-27,4-3-27, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Devamainolu Lakshmamma

414600220915

D Durga Bai

459383943525

D Ramu

907705098926

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743592

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 888173556020

Name of Head of Household

: Devi Sharma

Father/Husband Name

:-

Address

: 4-6-90/2/2,4-6-90/2/2,T N
COLONY HASSAN NAGAR
RAJENDRANAGAR
RANGAREDDY

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Devi Sharma

888173556020

Ramprasad Sharma

306145177366

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743606

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 899775328277

Name of Head of Household

: Guntthapally Padmavathi

Father/Husband Name

:-

Address

: 4-4-6/1,4-4-6/1,ATTAPUR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 656724

Family Members Details

SNo

Name

UID

Photo

Guntthapally Padmavathi

899775328277

Gunthapally Parvathamma

776384375000

Guntthapally Narayan
Reddy

518060330935

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743630

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 415148986262

Name of Head of Household

: Chilkuru Balamani

Father/Husband Name

:-

Address

: 4-4-97,4-4-97, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 08962

Family Members Details

SNo

Name

UID

Photo

Chilkuru Balamani

415148986262

C Nagaraju

294164013095

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743701

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 471427188675

Name of Head of Household

: P Jayasudha

Father/Husband Name

:-

Address

: 4-2-99,4-2-99, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 636464

Family Members Details

SNo

Name

UID

Photo

P Jayasudha

471427188675

P Naveen

673236891236

P Sneha

702886721593

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743797

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 212462619049

Name of Head of Household

: Jaligam Anuradha

Father/Husband Name

:-

Address

: 4-1159,attapur(M),Hyderabad(D)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Jaligam Anuradha

212462619049

J Pavanamma

989276816612

Jaligam Shankar

413827383287

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743866

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 564462428871

Name of Head of Household

: Kamadanam Suguna

Father/Husband Name

:-

Address

: 4-4-100,4-4-100, Attapur,
Bhagya Nagar, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 12468

Family Members Details

SNo

Name

Kamadanam Suguna

UID

Photo

564462428871

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743888

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 252269962863

Name of Head of Household

: A Padmamma

Father/Husband Name

:-

Address

: 4-4-68,4-4-68, Attapur, Bhagya

Nagar, Ward-4(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 1004135

Family Members Details

SNo

Name

UID

Photo

A Padmamma

252269962863

A Ramulu

434194823985

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743927

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 791316399435

Name of Head of Household

: D Manemma

Father/Husband Name

:-

Address

: 4-3-25/1,4-325/1,POCHAMMA BASTHI

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

D Manemma

791316399435

D Radika

756201159845

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743938

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 424603322804

Name of Head of Household

: Pannala Anjamma

Father/Husband Name

:-

Address

: 4-1-92,4-1-92, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Pannala Anjamma

UID

Photo

424603322804

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743950

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 271708519661

Name of Head of Household

: Rudraram Narsimha

Father/Husband Name

:-

Address

: 4-2-119/1,4-2-119/1, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Rudraram Narsimha

271708519661

Rudraram Balamma

699623818782

Rudraram Pallavi

681628262107

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370743985

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 226633211179

Name of Head of Household

: P Janamma

Father/Husband Name

:-

Address

: 4-1-86,4-1-86, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

P Janamma

UID

Photo

226633211179

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744006

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 794012943417

Name of Head of Household

: Radhika

Father/Husband Name

:-

Address

: 4-5-40/3/A,4-5-40/3/A, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Radhika

794012943417

A Madhu

658638100291

Madhavi

720347352707

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744026

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 613812680929

Name of Head of Household

: K Pochamma

Father/Husband Name

:-

Address

: 4-3-18,ATTAPUR RAJENDRA
NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

K Pochamma

613812680929

K Manikyam

802573730778

K ANITHA

331474825326

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744028

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 794448161084

Name of Head of Household

: D Pemtamma

Father/Husband Name

:-

Address

: 4-3-75,4-3-75,POCHAMMA
BASTHI

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

D Pemtamma

UID

Photo

794448161084

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744036

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 992741072684

Name of Head of Household

: Mamidi Saroja

Father/Husband Name

:-

Address

: 4-4-99,4-4-99, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Mamidi Saroja

UID

Photo

992741072684

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744039

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 529884377735

Name of Head of Household

: Gurram Yadamma

Father/Husband Name

:-

Address

: 4-2-97,4-2-97, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Gurram Yadamma

UID

Photo

529884377735

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744041

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 394649753738

Name of Head of Household

: Riyasat Begum

Father/Husband Name

:-

Address

: 4-3-129/2,ATTAPUR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Riyasat Begum

394649753738

Mohammed Mushtaq Pasha

642632742364

Amreen Sultana

988762902933

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744080

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 314439585578

Name of Head of Household

: Yata Swaroopa

Father/Husband Name

:-

Address

: 4-1-193,4-1-193, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Yata Swaroopa

UID

Photo

314439585578

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744097

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 750488994923

Name of Head of Household

: Vaddla Lalitha

Father/Husband Name

:-

Address

: ,4-1-5, Attapur, Attapur,

Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Vaddla Lalitha

750488994923

V Upender

850742911378

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744113

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 693922856914

Name of Head of Household

: P Yadamma

Father/Husband Name

:-

Address

: 4-1-12,4-2-87, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

P Yadamma

UID

Photo

693922856914

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744120

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 852914831778

Name of Head of Household

: M Shobharani

Father/Husband Name

:-

Address

: 4-1-142/1,RAJENDRA
NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 602819

Family Members Details

SNo

Name

M Shobharani

UID

Photo

852914831778

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744140

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 507193382392

Name of Head of Household

: Suroshi Kantha Bai

Father/Husband Name

:-

Address

: 4-7-113,4-7-113, Attapur,
Shivaji Nagar, Ward-3(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Suroshi Kantha Bai

507193382392

Satish

592842941281

Santosh

951200922028

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744166

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 351564464975

Name of Head of Household

: Savitramma Solanki

Father/Husband Name

:-

Address

: 4-2-17/1/C/1,ATTAPUR
RAJENDRA NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Savitramma Solanki

351564464975

Radha Solanki

366594551017

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744179

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 574706144869

Name of Head of Household

: Mahammadi Begam

Father/Husband Name

:-

Address

: 4-3-130/8/1,4-3-130/8/1,
Attapur, Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 17662

Family Members Details

SNo

Name

UID

Photo

Mahammadi Begam

574706144869

Afreen Sultana

895838909126

Md Ibrahim Kaleel Khan

328740937192

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744197

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 489620133577

Name of Head of Household

: Durgamma

Father/Husband Name

:-

Address

: 4-3-9/1/A,4-3-9/1/A, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Durgamma

489620133577

K Mallesh

989362089819

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744202

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 471963125720

Name of Head of Household

: Kota Sumalatha

Father/Husband Name

:-

Address

: 4-1-172/4/1/3,ATTAPUR
RAJENDRA NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 612937

Family Members Details

SNo

Name

UID

Photo

Kota Sumalatha

471963125720

Prathibha

338639139391

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744205

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 663544959991

Name of Head of Household

: Gummadi Muttamma

Father/Husband Name

:-

Address

: 4-1-50,4-1-50, Attapur,
Attapur, Ward-6(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Gummadi Muttamma

663544959991

Gummadi Santosh Reddy

764418682190

Gummadi Srikanth Reddy

712492267134

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744213

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 551073171342

Name of Head of Household

: Nagu Bai

Father/Husband Name

:-

Address

: 4-6-38,4-6-38, Attapur,
Rambagh, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Nagu Bai

551073171342

M Narsu Bai

224005350527

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744249

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 437638029204

Name of Head of Household

: Soyaamuthyam Satyamma

Father/Husband Name

:-

Address

: 4-2-108/1,4-2-108/1, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 12654669

Family Members Details

SNo

Name

UID

Photo

Soyaamuthyam Satyamma

437638029204

S Srinu

726351301517

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744268

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 348558041155

Name of Head of Household

: Panthula Kamalamma

Father/Husband Name

:-

Address

: 4-1-76/2,4-1-76/2, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Panthula Kamalamma

UID

Photo

348558041155

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744285

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 718636766837

Name of Head of Household

: Kallem Komarama

Father/Husband Name

:-

Address

: 4-4-62,4-4-62, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 32350

Family Members Details

SNo

Name

UID

Photo

Kallem Komarama

718636766837

K Mahipal Reddy

766012944560

K Babu Reddy

887331334455

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744298

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 424801049411

Name of Head of Household

: Paka Susheela

Father/Husband Name

:-

Address

: 4-2-17/2,4-2-17/2,ATTAPUR
NEAR TATION HYD

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 20296

Family Members Details

SNo

Name

Paka Susheela

UID

Photo

424801049411

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744311

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 261409164190

Name of Head of Household

: Pendur Anjamma

Father/Husband Name

:-

Address

: 4-2-105,4-2-105, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 658032

Family Members Details

SNo

Name

UID

Photo

Pendur Anjamma

261409164190

Malathi

630268206531

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744328

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 463295798052

Name of Head of Household

: B Sarojana

Father/Husband Name

:-

Address

: 4-4-71,4-4-71, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

B Sarojana

463295798052

B Venkataiah

997375014188

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744363

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 447289307152

Name of Head of Household

: Kota Gandamma

Father/Husband Name

:-

Address

: 4-3-17,4-3-17, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Kota Gandamma

447289307152

K Shankar Bai

250741345674

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744402

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 776660922655

Name of Head of Household

: M D Shahajadi Begum

Father/Husband Name

:-

Address

: 4-3-103/6,ATTAPUR
RAJENDRA NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

M D Shahajadi Begum

776660922655

Mohd Aleem

897336462151

Nayeem

714956012109

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744462

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 658608919489

Name of Head of Household

: Metla Sabitha

Father/Husband Name

:-

Address

: 4-7-145,4-7-145, Attapur, Sai

Nagar, Ward-3(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 802560

Family Members Details

SNo

Name

Metla Sabitha

UID

Photo

658608919489

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744463

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 479485033255

Name of Head of Household

: Chirra Ramaiah

Father/Husband Name

:-

Address

: 4-4-109,4-4-109, Attapur,
Bhagya Nagar, Ward-2(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Chirra Ramaiah

479485033255

C Narsamma

848069184738

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744471

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 298999981229

Name of Head of Household

: Samala Ramulamma

Father/Husband Name

:-

Address

: 4-1-76,4-1-76, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 610790

Family Members Details

SNo

Name

Samala Ramulamma

UID

Photo

298999981229

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744474

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 806697355483

Name of Head of Household

: Puppala Anasuya

Father/Husband Name

:-

Address

: 4-2-140/2,4-2-140/2, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Puppala Anasuya

806697355483

P Naresh

538444859132

P Harish

200303879681

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744503

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 404274450433

Name of Head of Household

: Soyam Kamalamma

Father/Husband Name

:-

Address

: 4-2-85/1,4-2-85/1, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Soyam Kamalamma

404274450433

Soyam Chander

360333643614

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744504

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 418988366827

Name of Head of Household

: Raziya Begum

Father/Husband Name

:-

Address

: 4-3-130/12,4-3-130/12, Attapur,
Khaja Nagar, Ward-7(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 23717

Family Members Details

SNo

Name

UID

Photo

Raziya Begum

418988366827

Naseem Begum

863462153287

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744509

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 900152011666

Name of Head of Household

: Dumpala Sathamma

Father/Husband Name

:-

Address

: 4-1-40,4-1-40, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Dumpala Sathamma

UID

Photo

900152011666

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744511

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 288857622570

Name of Head of Household

: K Prabhavathi

Father/Husband Name

:-

Address

: 4-2-26,ATTAPUR RAJENDRA
NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 2274963

Family Members Details

SNo

Name

UID

Photo

K Prabhavathi

288857622570

K Saiteja Reddy

986716259397

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744528

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 292961912769

Name of Head of Household

: Goska Ramulamma

Father/Husband Name

:-

Address

: 4-1-75,4-1-75, Hyderguda,
Attapur, Ward-7(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 610784

Family Members Details

SNo

Name

Goska Ramulamma

UID

Photo

292961912769

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744534

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 425454041026

Name of Head of Household

: Banke Bassu Bai

Father/Husband Name

:-

Address

: 4-7-156/9/A,4-7-154/9/A,
Attapur, Pandu Ranga Nagar,
Ward-3(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Banke Bassu Bai

425454041026

B Naganath

410909208079

B Balaji

398668668702

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744544

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 359663399564

Name of Head of Household

: Konda Satyamma

Father/Husband Name

:-

Address

: 4-2-18/4,ATTAPUR
RAJENDRA NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 66082

Family Members Details

SNo

Name

UID

Photo

Konda Satyamma

359663399564

Konda Pavan Kumar

979758689145

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744572

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 506015391310

Family Members Details

SNo

Name of Head of Household

: Mohammed Noorjahan Begum

Father/Husband Name

:-

Address

: 4-3-130/8/1,4-3-130/8/1,
Attapur, Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 17662

Name
Mohammed Noorjahan
Begum

UID

Photo

506015391310

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744628

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 358206351444

Name of Head of Household

: N Rajamani

Father/Husband Name

:-

Address

: PLOT NO. 367,PLOT NO. 367,

Attapur, Pandu Ranga Nagar,
Ward-24(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 624969

Family Members Details

SNo

Name

UID

Photo

N Rajamani

358206351444

N Raju

999167238423

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744696

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 890716042703

Name of Head of Household

: Tenugu Sathamma

Father/Husband Name

:-

Address

: 4-1-34,4-1-34, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Tenugu Sathamma

890716042703

Gudepu Susheela

506607992783

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744773

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 484148157927

Name of Head of Household

: Anugula Jyothi

Father/Husband Name

:-

Address

: 4-1-36,ATTAPUR RAJENDRA
NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 15495

Family Members Details

SNo

Name

UID

Photo

Anugula Jyothi

484148157927

Anugula Chaitanya Reddy

557519801210

Anugula Rahul Reddy

971885605564

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744806

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 406425486966

Name of Head of Household

: Kamar Sultana

Father/Husband Name

:-

Address

: 4-3-103/7/1,4-3-103/7/1,
Attapur, Kanta Reddy Nagar,
Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Kamar Sultana

406425486966

Sumayya Kausar

383782161642

Mohammed Nawaz

731894234695

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744839

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 533172033368

Name of Head of Household

: Mohd Zehra Bee

Father/Husband Name

:-

Address

: 4-4-3,4-4-3, Attapur,khaja
nagar

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 17902

Family Members Details

SNo

Name

Mohd Zehra Bee

UID

Photo

533172033368

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744903

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 968215126409

Name of Head of Household

: Vean Bai Anitha

Father/Husband Name

:-

Address

: 4-7-156/3/C,4-7-156/3/C,
Attapur, Panduranga Nagar,
Ward-3(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: 33932

Family Members Details

SNo

Name

UID

Photo

Vean Bai Anitha

968215126409

Chanabasva

728447600692

Vishal

265954036509

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744931

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 915901392210

Name of Head of Household

: Suddula Shyamala

Father/Husband Name

:-

Address

: 4-3-101,4-3-101, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: CX5737983

Family Members Details

SNo

Name

UID

Photo

Suddula Shyamala

915901392210

Suddula Anand

420363278786

S Sarada

257196879636

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370744954

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 909804364310

Name of Head of Household

: Disouja Elizabeth

Father/Husband Name

:-

Address

: 4-3-130,4-3-130, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

: CX5771836

Family Members Details

SNo

Name

Disouja Elizabeth

UID

Photo

909804364310

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370745044

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 659095808297

Name of Head of Household

: Devamola Lakshmaiah

Father/Husband Name

:-

Address

: 4-3-14,4-3-14, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Devamola Lakshmaiah

659095808297

D Gandamma

493635924837

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370745088

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 660425999114

Name of Head of Household

: Sohra Bee

Father/Husband Name

:-

Address

: 4-3-103/7/1,ATTAPUR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: Yes

LPG Consumer No.

Family Members Details

SNo

Name

UID

Photo

Sohra Bee

660425999114

Md Abdul Khadar

929205849277

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370745098

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 526619869549

Name of Head of Household

: S Durgamma

Father/Husband Name

:-

Address

: 4-3-50,attapur RAJENDRA
NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

S Durgamma

UID

Photo

526619869549

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370745142

Card Type

: AFSC

F.P Shop No

: 1583005

UID

:-

Name of Head of Household

:-

Father/Husband Name

:-

Address

: 4-7-175/1,4-7-175/1, Attapur,
Panduranga Nagar, Ward-3(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Cherla Lavanya Kumari

UID

Photo

555779161360

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370745168

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 615453568651

Name of Head of Household

: Devanamahina Durgamma

Father/Husband Name

:-

Address

: 4-3-68/1,4-3-68/1, Attapur,
Attapur, Ward-1(V)

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Devanamahina Durgamma

UID

Photo

615453568651

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre

DECLARATION FORM
Card No

: 365370806262

Card Type

: AFSC

F.P Shop No

: 1583005

UID

: 431719378205

Name of Head of Household

: Kashigari Kistamma

Father/Husband Name

:-

Address

: 4-1-57/1,
ATTAPUR,RAJENDRA
NAGAR

Mandal

: CIRCLEIII(SAROORNAGAR)

District

: Ranga Reddy

Gas Connection :

: No

LPG Consumer No.

Family Members Details

SNo

Name

Kashigari Kistamma

UID

Photo

431719378205

CARD HOLDER
1. I have (

) Ticked all the places / fields where there are NO mistakes

2. I have provided correct details at all places / fields, where there are mistakes / blanks / inclusions to be done.
3. All deletions to be done have been struck off.
4. All the members whose names are included in this card are my family members who reside with us and their names are not included in
any other FSC card anywhere in this State or Outside the State.
5. I am aware that the income of all the family members put together is not more than Rs.2 Lakh(in Urban Areas) / Rs1.5 lakh(in
Rural areas) per annum and I am also aware that the Scheduled Commodities that are supplied on the Food Security Card to be issued
shall be used only for my Household consumption and not for any pecuniary gains.
6. In case any information given above is proved to be false I am aware that I am liable for prosecution.
Signature of card holder
Sl No of the member

FP SHOP DEALER
1. I shall assist the Civil Supplies Department in ensuring the details on the card are accurate and the cardholders are eligible.
2. This form is submitted to me by the cardholder / member personally whose name is mentioned at Sl No:____ and to the best of my
knowledge, is accurate.
3. I affirm that the beneficiaries / cardholders are not fictitious and that they are residents in the area catered to by my FPS and I affirm
that I have no intention of illegal pecuniary gains by mis-representation.
4. I am aware that I am liable for action under the provisions of APS PDS control Order-2008 read with the provisions of the EC Act-1955
and any other law applicable, in case it is proved that I have contravened the said provisions..
Signature of FPS Dealer
FPS NO:________
Seal:.

FOR OFFICE USE

I have read the above carefully and found all the details are filled in and signed by the appropriate persons. On verification of the
details with aadhaar details, they are found to be genuine / not genuine.
Signature
VRO/Inspector

Page No.1

Signature
Tahsildar/ASO

Report Generated by Telangana Food & Civil Supplies Dept., Application Developed by National Informatics Centre