Deletion Certificate Ration Card

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					                            Surrender / Deletion Certificate

         Certified that the Name of Sh./Smt/ …………………………………………… S/o,
D/o,     W/o        ………………………………………………………………….                              Resident    of
………………………………………………………………………… has been deleted from
the Ration Card No. …………………………………….. issued in the Name of Sh./Smt.
……………………………………………………….


                                                                            DFSO/ AFSO
                                                                              With Seal
Place:
Date:

2. Verified that Ration Card No. 1 ……………………………. For the members, detailed
      below, issued to Sh. /Smt. ………………………………………. S/o, W/o, D/o
      ………………………………….. resident of ……………………………. Has been
      retained/ taken back in this office because the person has shifted/ transferred from
      this place.
Sr.        Name of the Member                Father’s Name         Age
No.
1.
2.
3.
4.
5.
Place:
Dated:
                                                                   DFSO/ AFSO
                                                                   (Seal)

				
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