FORM - J APPLICATION FOR SURRENDERING FOOD CARD 1. Name and address of the food Card Holder........................ 2. F.P.S. No........Registration No.......R/W/............... 3. Units........Sugar........Cereal.........Ration drawn upto...... 4. Name of the member included in the Food Card. 1................. 3.................. 2................. 4.................. 5. Reasons 1. Leaving Delhi for stay outside (name of the place)................... 2. Shifted residence in the area outside the Circle from................... 3. Maintaining the same residence but fall in the jurisdiction of the other circle 6. Surrender certificate required or not........................... Date:........ Signature of the applicant.
