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	:	SANJAY KUMAR DAS
Father's/Spouse Name	:	MOHANANDA DAS		DOB	:	25-05-1964
AGE	:	60		Aadhar No	:	526165870858
	Gender	:	Male
Mobile No	:	9337444823		District	:	SUNDARGARH
Sub-division	:	SUNDARGARH		Address Type	:	ULB
ULB Type	:	Municipality		Municipality	:	Sundargarh Municipality
City/Town	:	Rourkela		Ward No	:	WARD-17
House No/Plot No	:	EM 26		PIN	:	769012
Social Category(Caste)	:	General
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/12/15/2024/222480

Bank Account Details
Bank Account Type	:	Single Account	Account Holder Name	:	Sanjay Kumar Das
Account Number	:	134910100069000	IFSC Code	:	UBIN0574872
Bank Name	:	UNION BANK OF INDIA	Branch Name	:	CIVIL TOWNSHIP ROURKELA

Declaration

I Mr/Mrs SANJAY KUMAR DAS 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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