Registration of Consumers for Transparency in PDS
Details of the FPS Dealer for whom information is sought
District Name
*
:
--Select--
ANGUL
BALASORE
BARGARH
BHADRAK
BOLANGIR
BOUDH
CUTTACK
DEOGARH
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHPUR
JAJPUR
JHARSUGUDA
KALAHANDI
KANDHAMAL
KENDRAPARA
KEONJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NAWARANGPUR
NAYAGARH
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SUBARNAPUR
SUNDERGARH
Block / ULB
*
:
--Select--
GP / Ward No.
*
:
--Select--
Dealer (for Rice/Wheat/Sugar)
*
:
--Select--
Dealer (for Koil )if different from above
:
--Select--
Details of the Consumer
Name
*
:
Gender
*
:
Male
Female
Relations Name
*
:
Relation
*
:
Father
Husband
Mobile / Phone No.
*
:
Do you have ration card
*
:
Yes
No
Ration Card No.
:
Ration Card type
:
--Select--
APL
BPL
AAY
Annapurna
Are you a member of
:
None
PRI
BLAC
GRLAC
TLAC
WLAC
NGO
Your Designation
:
Name of NGO ( NGO
)
:
Declaration :
I hereby declare that all the particulars furnished above are correct to the best of my knowledge . I shall be held responsible for any incorrect information.
