SSEPD::Social Security & Empowerment of Persons With Disabilities Department

Madhu Babu Pension Yojana Application Form

Madhu Babu Pension Yojana Application Form
Pension Type	:	Disability Pension		Name	:	SHASHTI BHOI
Father's/Spouse Name	:	DAMODAR BHOI		DOB	:	07-10-1989
AGE	:	34		Aadhar No	:	936486929868
	Gender	:	Female
Mobile No	:	8093968144		District	:	SONEPUR
Sub-division	:	SONEPUR		Address Type	:	Block
Block	:	SONEPUR		GP	:	MAYURUDAN
Village	:	RUGUDIPALI		Habitation	:	RUGUDIPALI
House No/Plot No	:	123		PIN	:	767017
Social Category(Caste)	:	SC
Disability Type	:	Hard of Hearing		UDID Certificate Number	:
The parental/family income of the applicant is not more than Rs.60,000/-per annum.	:	Yes		Has not been convicted of any criminal offence involving moral turpitude.	:	Yes
Is a permanent resident/domicile of Odisha since 20 years.	:	Yes		Application Number	:	SSEPD/BNFAPP/MBPY/09/19/2022/246622

Bank Account Details
Bank Account Type	:	Single Account	Account Holder Name	:	SHASHTI BHOI
Account Number	:	611502010020083	IFSC Code	:	UBIN0561151
Bank Name	:	UNION BANK OF INDIA	Branch Name	:	SONEPUR

Declaration

I Mr/Mrs SHASHTI BHOI truely declare that:

The parental/family income of the applicant is not more than Rs.60,000/-per annum.

Has not been convicted of any criminal offence involving moral turpitude.

Is a permanent resident/domicile of Odisha since 20 years.

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately.In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it and that my pension will be terminated.

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