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Household Splitting Application Form

This document is an application form for splitting household members. It collects information such as applicant details including name, father/husband's name, gender, date of birth, caste, religion, qualification, and mobile number. It also collects household member details including name, gender, status, marital status, date of birth, caste, relationship to applicant, type of split, and desired household. The form allows selecting head of family and service type as marriage split or existing household. It has sections for entering details of household number 1 and household number 2 along with their eKYC status and relationship to head of household.

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suhas marla
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2K views1 page

Household Splitting Application Form

This document is an application form for splitting household members. It collects information such as applicant details including name, father/husband's name, gender, date of birth, caste, religion, qualification, and mobile number. It also collects household member details including name, gender, status, marital status, date of birth, caste, relationship to applicant, type of split, and desired household. The form allows selecting head of family and service type as marriage split or existing household. It has sections for entering details of household number 1 and household number 2 along with their eKYC status and relationship to head of household.

Uploaded by

suhas marla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Splitting of Household Members Application Form

Applicate Details
Applicant Aadhar:_________________________ Applicant Name:-____________________________________
Applicant Father/Husband Name:-__________________ Gender:-Male/Female DOB_____________
Caste:-BC-A,BC-B,BC-C,BC-D,BC-E,SC,ST,OC Religion:-_________________ Qualification:-_________
Married Status:- Married,Unmarried,Widow,Single Women, Divorced Mobile No_______________

Household Member Details


Select Head of Family: Service Type:- Marriage Split/Existing Household

Sl Name of the eKYC Gender* Status* Marital DOB Cast Relatio Split Type* Desired
n Citizen Statu Status* e nship Household*
o s
1 Y Male/ Alive/ Married/Un Existing HH/ Household-1/
Female Dead married Marriage Household-2
2 Y Male/ Alive/ Married/Un Existing HH/ Household-1/
Female Dead married Marriage Household-2
3 Y Male/ Alive/ Married/Un Existing HH/ Household-1/
Female Dead married Marriage Household-2
4 Y Male/ Alive/ Married/Un Existing HH/ Household-1/
Female Dead married Marriage Household-2
5 Y Male/ Alive/ Married/Un Existing HH/ Household-1/
Female Dead married Marriage Household-2
6 Y Male/ Alive/ Married/Un Existing HH/ Household-1/
Female Dead married Marriage Household-2
* Strike off remaining data
Household Number 1 Household Number 2
Select Head of Household 1_____________________________ Select Head of Household 2_______________________________

Sl.no Name of the Citizen Relationship Sl.no Name of the Citizen Relationship

eKYC for Household 1 eKYC for Household 2

Proof of Document for Household 1

Proof of Document for Household 2

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