Government of West Bengal Duare Sarkar Regn. No.
Food & Supplies Department
Common Application Form
For all Digital Ration Card related services
(Please read all the instructions and eligibility criteria and fill the forms carefully)
PART 1 : Application (All applicants have to MANDATORILY fill this part)
I,___________________________________________________ , want to apply for (Select any one of the services)
SERVICE NO.
1.(Form 3) Inclusion of full family for subsidized food grains under NFSA / RKSY
2.(Form 4) Inclusion of left out family members in already existing family under NFSA/RKSY/
General Digital Ration Card
3.(Form 10) General/Non-subsidized Digital Ration Card
4.(Form 5) Rectification of spelling mistakes in name, age and address within the same
block/municipality in existing Digital Ration Card
5.(Form 8) Conversion of RKSY-2 / General (Form-10) Digital ration Card to RKSY- 1
Conversion of subsidized to non-subsidized Digital Ration Card
Change of Ration Shop due to 1. Shifting of full family
6.(Form 2. Shifting of partial family
6,13,14) 3. Shifting of Individual due to marriage/divorce/other
3.1. In case of marriage, please write DRC of one of
the members of the new family Category: Category
7.(Form 7) Surrender of Digital Ration Card due to 1. Death 2. Migration 3. Voluntarily
8.(Form 15) Representative Nomination by families having no Aadhaar linked member
I CERTIFY THAT ME/MY FAMILY BELONGS TO - SC ST
PART 2 : Aadhaar Details of Existing Digital Ration Card Holders (In Case of more than 4 applicants, please take one annexure of this Part and attach that with this form)
Member Tick DRC Number Mention DRC Aadhaar Number
No. If Category
Differently (AAY/PHH/SPHH
abled /
RKSY 1/RKSY 2)
1
2
3
4
PART 3: Details of Family Member (Mandatory) For services No.4 or 6(2) or 6(3) enter only details of those family members
For Service No.8 enter the beneficiary name in 1st applicant and the details of the nominnes in 2nd and 3rd applicant
* Name of 1st applicant / Head of
Family (HOF) as in Aadhaar
*Relation with HOF
*Name of Father /Mother / Spouse
*Mobile No. *DOB D D M M Y Y Y Y
*Aadhaar No. Tick if Differently Abled
Ration Card No. (If Applicable) Category
* Name of 2nd applicant as in Aadhaar
*Relation with HOF
*Name of Father/Mother/Spouse
*Mobile No. *DOB D D M M Y Y Y Y
*Aadhaar No. Tick if Differently Abled
Ration Card No. (If Applicable) Category
* Name of 3rd applicant as in Aadhaar
Government of West Bengal Duare Sarkar Regn. No.
Food & Supplies Department
Common Application Form
For all Digital Ration Card related services
(Please read all the instructions and eligibility criteria and fill the forms carefully)
*Relation with HOF
*Name of Father/Mother/Spouse
*Mobile No. *DOB D DM M Y Y Y Y
*Aadhaar No. Tick if Differently Abled
Ration Card No. (If Applicable) Category
* Name of 4th applicant as in Aadhaar
*Relation with HOF
*Name of Father/Mother/Spouse
*Mobile No. *DOB D D M M Y Y Y Y
*Aadhaar No. Tick if Differently Abled
Ration Card No. (If Applicable) Category
(In Case of more than 4 applicants, please take one annexure of this Part and attach that with this form)
PART 4: Details of Present Address (Mandatory for Service No. 1,2,3,4,6,8 in Part-1)
*District
Sub-division
*Block Name / Municipal
Corporation / Municipality
* GP Name /Ward No.
Village Name
*Flat/House No. / Building Landmark
*Street / Lane Name
*Pin Code
*Post *Police
Office Station
PART 5 : Ration Shop Details (Mandatory for Service No. 1,2,3,4,6,8 in Part-1)
I want to apply *New Ration Shop Licensee Name
for getting
subsidized New Ration Shop Code Number
SK Oil
*New Kerosene Shop Licensee Name
New Kerosene Shop License Number
No member of my family has ever held a Ration Card prior to this. (Please tick if you are applying for service No. 1 in
Part-1)
I hereby certify that -
1. I agree that all inputs and information given above are true to the best of my knowledge. I agree that the application
may be rejected, or the Ration Card, if issued, may be cancelled if any information furnished here is found to be
false.
2. I also acknowledge that other legal action may be taken against me for furnishing wrong information or hiding any
relevant information, either at the time of application or at later stage.
3. I have submitted Aadhaar Data voluntarily.
4. I agree that my mobile number could be used for receiving communications from Department of Food & Supplies,
Government of West Bengal.
Signature/LTI of the applicant / HOF
For Online Application Please visit https://www.food.wb.gov.in or WhatsApp 9903055505
