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

Madhu Babu Pension Yojana Application Form

Madhu Babu Pension Yojana Application Form
Pension Type	:	Old Age Pension		Name	:	NARENDRA MAHAKUD
Father's/Spouse Name	:	PURNA CHANDRA MAHAKUD		DOB	:	05-04-1962
AGE	:	60		Aadhar No	:	Not Captured
	Gender	:	Male
Mobile No	:	9937267824		District	:	BALESHWAR
Sub-division	:	BALASORE		Address Type	:	Block
Block	:	BASTA		GP	:	PATHARJHARA
Village	:	SULEMANPUR		Habitation	:	SULEMANPUR
House No/Plot No	:			PIN	:	756029
Social Category(Caste)	:	OBC
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/02/06/2023/825649

Bank Account Details
Bank Account Type	:	Single Account	Account Holder Name	:	NARENDRA MAHAKUD
Account Number	:	20244115812	IFSC Code	:	SBIN0013583
Bank Name	:	STATE BANK OF INDIA	Branch Name	:	BASTA

Declaration

I Mr/Mrs NARENDRA MAHAKUD 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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