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	:	GEDELA PAGADALAMMA
Father's/Spouse Name	:	GEDELA CHANDRA SHEKHARAMU		DOB	:	08-08-1960
AGE	:	62		Aadhar No	:	855801631022
	Gender	:	Female
Mobile No	:	7995507077		District	:	GAJAPATI
Sub-division	:	PARALA-KHEMUNDI		Address Type	:	Block
Block	:	GOSANI		GP	:	BAGASALA
Village	:	BAGASOLA		Habitation	:	BAGASOLA
House No/Plot No	:	244/356		PIN	:	761211
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/04/05/2023/257634

Bank Account Details
Bank Account Type	:	Single Account	Account Holder Name	:	GEDELA PAGADALAMMA
Account Number	:	50230013906334	IFSC Code	:	BDBL0001030
Bank Name	:	BANDHAN BANK	Branch Name	:	BHUBANESWAR

Declaration

I Mr/Mrs GEDELA PAGADALAMMA 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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