Meeseva Replacement of Existing FP Shop Authorization -Application Form

Meeseva Replacement of Existing FP Shop Authorization -Application Form

Download Here Replacement of Existing FP Shop Authorization -Application Form
The Replacement of Existing FP Shop Authorization -Application Form will be like below download the form and fill all the details and attach required documents:

Replacement of Existing FP Shop Authorization -Application Form:
Replacement of Existing FP Shop Authorization
Applicant Details:-
Aadhaar Number*: _________________________________
Father/Husband Name*: ________________
Door No*: _________________ Locality/Land Mark
District*: _________________________ Mandal
Pin Code*: _________________Qualification
Caste *: BCA BCB BCC BCD OC
Weather Physically Handicapped*: YES
Service Specific Details:-
Whether the applicant is connected with any other business run either by himself or by any member of his family
YES NO. If Yes, Mention the Remarks: ___________________
Whether any one of applicant's blood relations is working in Revenue/Civil
YES NO. If Yes, Mention the Remarks: ___
Whether he was convicted earlier for any offence under any Control Order issued by the State/Centre under E.C. Act 1955
YES NO. If Yes, Mention the Remarks: ____________________________
Whether any member of the applicant's family has been issued authorization to run Fair Price Shop earlier
YES NO. If Yes, Mention the Remarks: ________________________________________
Whether he can raise sufficient funds to run Fair Price Shop with his own funds and if so give source or whether he needs
institutional finance *: YES NO. If Yes, Mention the Remarks: _________________________________________


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FP Shop Location Details:-
Door No*: _________________ Location*
Mandal*: _____________________________ Village/Ward
Trade Deposit National Saving Certificate Details For FP Shops/Nominal Retailers:
Deposit Amount *(In Rupees): ____________
National Saving Certificate Paid Date* :_______________________(DD/MM/YYYY)

Replacement of Existing FP Shop Authorization
: _________________________________Applicant Name *: __________________________
_______________________ Date of Birth*: ________________________
: _________________ Locality/Land Mark*: ___________________________________________________________
Mandal*: ________________________ Village/Ward*: _______
Qualification*: __________________________________________________
OC S.C S.T BCE Gender*: Male
YES NO
Whether the applicant is connected with any other business run either by himself or by any member of his family
NO. If Yes, Mention the Remarks: ___________________________________________________________________
Whether any one of applicant's blood relations is working in Revenue/Civil Supply Dept/Civil Supply Corp
NO. If Yes, Mention the Remarks: ___________________________________________________________________
Whether he was convicted earlier for any offence under any Control Order issued by the State/Centre under E.C. Act 1955
NO. If Yes, Mention the Remarks: _____________________________________________________
Whether any member of the applicant's family has been issued authorization to run Fair Price Shop earlier
NO. If Yes, Mention the Remarks: _________________________________________________________________
Whether he can raise sufficient funds to run Fair Price Shop with his own funds and if so give source or whether he needs
NO. If Yes, Mention the Remarks: _________________________________________
*:__________________________________ District*: ____________
_________ Village/Ward*: ________________________ Pin Code*: _____
Trade Deposit National Saving Certificate Details For FP Shops/Nominal Retailers:
________________________ National Saving Certificate Number*: ______________________
_______________________(DD/MM/YYYY)
: ______________________
_________________________________________________________
Male Female
Whether the applicant is connected with any other business run either by himself or by any member of his family*:
_______________________
Supply Corp*:
_______________________________________
Whether he was convicted earlier for any offence under any Control Order issued by the State/Centre under E.C. Act 1955*:
_______________________________________
Whether any member of the applicant's family has been issued authorization to run Fair Price Shop earlier *:
___________________________
Whether he can raise sufficient funds to run Fair Price Shop with his own funds and if so give source or whether he needs
NO. If Yes, Mention the Remarks: ________________________________________________
____________________
: ___________________
Trade Deposit National Saving Certificate Details For FP Shops/Nominal Retailers:
______________________

Informant Details:-
Informant Name*: ___________________
Email ID: _______________________________________________
Document List: - (NOTE: All Upload Documents are in PDF format only)
Form 1*
Trade Deposit – National Saving Certificate
Passport Size Photo* (JPEG Format)
Aadhaar*
Date of Birth Certificate*
Physically handicapped Certificate (in case of PH)
Educational Certificate*
Caste Certificate for SC/ST
Category – Device - Load Det

____ Relation*: __________________________ Mobile No*: ___________________
Email ID: _______________________________________________ Delivery Type*: Manual  
Local Post
(NOTE: All Upload Documents are in PDF format only)
National Saving Certificate *
(JPEG Format)
Physically handicapped Certificate (in case of PH)

 Applicant’s Signature