Appendix ‘D’
APPLICATION FOR ISSUE OF IDENTITY CARD FOR EX-SERVICEMEN
1. Number ___________________
2. Rank ____________________
3. Name ________________________________________________
4. Regiment/Corps ________________________________________
5. Father’s Name _________________________________________
6. Address ____________________________________________________________________________________________________________________________________
Tehsil or Police Station ________________________ Tele :
______________________
7. Date of Birth _________________________
8. Date of Enrolment _______________________
9. Date of Discharge _______________________
10. Amount of Pension
(a) Service Pension Rs. _________________________________
(b) Disability Pension Rs. _______________________________
(c) Percentage of Disability ______________________________
11. Discharge Book No. & Date ________________________________________________
12. P.P.O. No. & Date _______________________________________________________
13. Identification Mark _______________________________________________________
14. Left Thumb Impression ____________________________________________________
DECLARATION
I hereby declare that the particulars given above are true to the best of my knowledge and belief.
Date : _____________________
Place : ____________________
(Signature of the
Applicant)