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	:	SANIA MUDULI
Father's/Spouse Name	:	LACHHA MUDULI		DOB	:	01-01-1962
AGE	:	61		Aadhar No	:	912099580113
	Gender	:	Male
Mobile No	:	8658567844		District	:	MALKANGIRI
Sub-division	:	MALKANGIRI		Address Type	:	Block
Block	:	KORUKONDA		GP	:	NAKAMAMUDI
Village	:	BATANKIAGUDA		Habitation	:	BATANKIAGUDA
House No/Plot No	:	00		PIN	:	764051
Social Category(Caste)	:	ST
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/02/23/2023/263253

Bank Account Details
Bank Account Type	:	Single Account	Account Holder Name	:	Sania Muduli
Account Number	:	34893740490	IFSC Code	:	SBIN0004853
Bank Name	:	STATE BANK OF INDIA	Branch Name	:	ORKEL

Declaration

I Mr/Mrs SANIA MUDULI 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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