Application Format:
Application For Senior Citizen Certificate :
1. Name of the Applicant :-
2. Name of Father / Husband :-
3. Date of Birth :- (Age Certificate by Govt. Doctor/School Certificate is enclosed)
4. Address :-
a. Village / Town :-
b. G.P./ Ward :-
c. Police Station :-
d. Post Office :-
5. Occupation :-
6. Blood Group :-
7. Identification Mark :-
8. Comments of Ward Commissioner / Gaonburah :-That the Applicant is a Senior Citizen residing within this jurisdiction :-
Signature & Seal of Ward Commissioner / Gaonburah
Date of Application :-
Signature of Applicant
(For Office Use) :
Application ID : Date of Receipt:
Service charge Rs. _________ Date of Delivery :
Signature of receiving assistant
Download Format Here : https://www.indianjobtalks.in/uploads…icate_form.pdf
Documents Required :
1. Age Proof Certificate attested by Competent Authority (Govt. Medical/Health Officer) OR any document of proof of age
2. Passport size photograph
3. Other Documents (if any)
4. Proof of retired Govt. servant
5. For the citizen other than Retired Govt. Servent – Copy of voter list of 1966t
6. For the citizen other than Retired Govt. Servent – Copy of land document