GOVERNMENT OF SIKKIM
SOCIAL WELFARE
DEPARTMENT
GANGTOK
APPLICATION
FORM FOR GRANT OF OLD AGE PENSION
Name of
applicant_____________________________________________________________
Father’s Name/Husband’s Name__________________________________________
Date of Birth____________________________________________________
Whether Husband/Wife is
receipient of Old
age
pension________________________________________________________
Gram
Panchayat Unit No. and Name_________________________________
Name of
ward___________________________________________________
Constituency____________________________________________________
Sub-Division____________________________________________________
District_________________________________________________________
Name
of Children Age Occupation
The information given above are true
to the best of my belief and knowledge. Further, if at any time the department
finds that the information give are/is incorrect, I agree to surrender the
passbook issued to the me under these rules.
SIGNATURE
OF THUMB
IMPRESSION OF THE APPLICANT
To be enclosed
3 recent size photographs
Attested photocopy of Sikkim Subject
Certificate/Certificate of Identification.
Attested photocopy of B.P.L.
Certificate.
PANCHAYAT RECOMMENDATION
It
is certified that the applicant is___________________years old and is poor and
needy person. Hence, his/her application for old Age Pension is hereby
recommended.
Signature________________________________
Full Name________________________________
Seal
M.L.A. RECOMMENDATION
Application of the applicant is hereby recommended.
Signature____________________________________
Seal.
FOR OFFICAL USE ONLY
Application received alongwith
Passphotos________________Nos.
Sikkim Subject/Certificare of
Identification (Photocopy)
Full
Name_________________________________________
Designation________________________________________
Date______________________________________________