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HH Split Verification NEW

The HH Split Field Verification Form is used to collect personal and household information of applicants seeking verification for split cases, such as marriage or divorce. It includes sections for applicant details, household split details, types of splits, and documentation verification status. Additionally, it captures remarks and recommendations from WEA/WWDS and PS/WAS personnel involved in the verification process.

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lp.vamsikrishna
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14 views2 pages

HH Split Verification NEW

The HH Split Field Verification Form is used to collect personal and household information of applicants seeking verification for split cases, such as marriage or divorce. It includes sections for applicant details, household split details, types of splits, and documentation verification status. Additionally, it captures remarks and recommendations from WEA/WWDS and PS/WAS personnel involved in the verification process.

Uploaded by

lp.vamsikrishna
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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HH Split Field Verification Form

Secretariat Name : Secretariat Code :


Volunteer Name : Volunteeer ID :
Applicant Details :
Name Of the Applicant :

Father / Husband Name :

Aadhar Number : Mobile Number :

Gender : Caste : SC/ST/BC-___ Sub-Caste :

Date of Birth : Age :

House Hold Split Details :


Family - 1
Marital Relation
Aadhar Number Person Name Age Gender
Status with HOF

Family - 2
Marital Relation
Aadhar Number Person Name Age Gender
Status with HOF
Type of Split : ( ) Marriage Split / ( ) Widow / Widower /Divorcee Split

Documents Provided :
Aadhar Cards : ( ) Submitted/ ( ) Not Submitted - ( ) Verified / ( ) Not Verified

Marriage Certificate : ( ) Submitted/ ( ) Not Submitted - ( ) Verified / ( ) Not Verified

Aarogya Sri Card : ( ) Submitted/ ( ) Not Submitted - ( ) Verified / ( ) Not Verified

EHS Card : ( ) Submitted/ ( ) Not Submitted - ( ) Verified / ( ) Not Verified

Rice Card : ( ) Submitted/ ( ) Not Submitted - ( ) Verified / ( ) Not Verified

Passport : ( ) Submitted/ ( ) Not Submitted - ( ) Verified / ( ) Not Verified

Death Certificate : ( ) Submitted/ ( ) Not Submitted - ( ) Verified / ( ) Not Verified

Divorce Certificate : ( ) Submitted/ ( ) Not Submitted - ( ) Verified / ( ) Not Verified

WEA / WWDS Remarks :

Recommended / Not Recommended :


WEA/ WWDS Name :
WEA Employee ID :
Verification Time & Date :

PS/WAS Remarks :

Recommended / Not Recommended :


PS/WAS Name :
PS/WAS Employee ID :
Verification Time & Date :

Applicant Signature Sign of the WEA/WWDS Sign of the PS/WAS

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