GOVERNMENT OF SIKKIM SOCIAL WELFARE/WELFARE DEPARTMENT GANGTOK APPLICATION FORM FOR GRANT OF OLD AGE PENSION 1. Name of applicant_____________________________________________________ 2. Father' s Name/Husband' s Name__________________________________________ 3. Date of Birth_________________________________________________________ 4. Whether Husband/Wife is recipient of Old age pension________________________ 5. Gram Panchayat Unit No. and Name_______________________________________ 6. Name of ward_________________________________________________________ 7. Constituency__________________________________________________________ 8. Sub-Division__________________________________________________________ 9. District______________________________________________________________ 10. Name of Children Age Occupation The information given above are true to the best of my belief and knowledge. Further, if at any time the department finds that the information give are/is incorrect, I agree to surrender the passbook issued to the me under these rules. SIGNATURE OF THUMB IMPRESSION OF THE APPLICANT To be enclosed 1. 3 recent size photographs 2. Attested photocopy of Sikkim Subject Certificate/Certificate of Identification. 3. Attested photocopy of B.P.L. Certificate. Downloaded from CIC PANCHAYAT RECOMMENDATION It is certified that the applicant is___________________years old and is poor and needy person. Hence, his/her application for old Age Pension is hereby recommended. Signature________________________________ Full Name________________________________ Seal M.L.A. RECOMMENDATION Application of the applicant is hereby recommended. Signature_______________________________ Seal. FOR OFFICAL USE ONLY Application received along with 1. Pass size photos________________Nos. 2. Sikkim Subject/Certificate of Identification (Photocopy) Full Name________________________________________ Designation_______________________________________ Date_____________________________________________ Downloaded from CIC
