APPLICATION FORM FOR OLD AGE PENSION FOR THE AGE OF 65 YEARS AND ABOVE (CENTRAL) TO BE FILLED UP BY THE APPLICANT 1. District 2. 3. Full Address4. 5. Category SC/ST/ WomenLandless Handicapped General Age on date of application6. 7. Identification mark I do solemnly affirm that8. i) I do not have family income of Rs. 5000/- per annum or more. ii) I have/ have not applied previously for grant of old age pension under NSAP. iii) I am resident of state where I have been residing during the three years immediately before the date of application. iv) I declare that the information furnished in the application is true and correct to the best of my knowledge and belief. Signature of thumb impression of the applicant Place Result of preliminary enquiry by the village level team : (Head GaonBura and senior most 1. Age Income/Destitution2. Category/Domicile3. Published on National Portal of India (india.gov.in) Block/ Municipality Village/ Panchayat/ Mohalla/ House No. Shri/ Smt. HusbandFather/ Name of teacher/ supervisor/ EO/ SA) district/ 4. Whether applying for the first time Recommendation5. Signature of verifying person at the village level Dated Name 2. 1. Address Note : This application should be sent with full particulars to the CO/EAC concerned. Recommendation of the Date Published on National Portal of India (india.gov.in) if not, the decision on the last application Yes No CO/ EACSignature of CO/ EAC
