Government of West Bengal

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. Inclusion of full family for subsidized food grains under NFSA / RKSY
2. Inclusion of left out family members in already existing family under NFSA/RKSY
3. General/Non-subsidized Digital Ration Card
4. Rectification of spelling mistakes in name, age and address within the same
block/municipality in existing Digital Ration Card
5. 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. 2. Shifting of partial family
3. Shifting of Individual due to marriage/divorce/other
7. Surrender of Digital Ration Card due to 1. Death 2. Migration 3. Voluntarily

8. Duplicate Digital Ration Card due to 1. Loss 2. Damaged 3. Defaced

I CERTIFY THAT ME/MY FAMILY BELONGS TO - SC ST

PART 2 : Aadhaar Details of Existing Digital Ration Card Holders (Mandatory)

Member Tick DRC Number Mention DRC Aadhaar Number (Mandatory) If required any
No. If Category service for existing
Differently (AAY/PHH/SPHH/ family members,
abled RKSY 1/RKSY 2) please mention the
‘Service No.’ from
Part 1
1
2
3
4
(In Case of more than 4 applicants, please take one annexure of this Part and attach that with this form)
PART 3: Details of Applicant/Family Member (Mandatory for Service No. 1,2,3,4,6,8 in Part-1)
* 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
* 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
* Name of 3rd applicant as in Aadhaar

*Relation with HOF

*Name of Father/Mother/Spouse
 Government of West Bengal
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)

*Mobile No. *DOB D D M M Y Y Y Y

*Aadhaar No. Tick if Differently Abled
* 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
(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 License 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

 Government of West Bengal
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)
Annexure 1: Auto-exclusion Criteria and Deprivation Criteria –Urban

Auto-exclusion Criteria[Tick (√) where applicable]*

(You must not fall under any of the following criteria to be eligible to get a ration card)
I certify that I / my family Tick here
1. do not live in a house with 3 or more than 3 rooms made of concrete wall and roof.

2. do not have any of the following consumer goods: a) four wheeler motorized card, b)AC machine, c) Computer or
Laptop with internet facility
3. do not have more than one of the following consumer goods – Refrigerator, Landline telephone, Washing Machine,
Two wheeler motorized vehicle
4. do not have any person who pays Income Tax or Professional Tax

5. do not have any member who is a Gazetted or non-Gazetted employee of State / Central Govt. Undertaking/ Govt.
Aided / Statutory / Autonomous bodies
Deprivation Criteria [Tick (√)where applicable]*
(You must fulfil at least one criteria to get a ration card)
I certify that I/my family, Tick here
1. live in house with wall and roof made of grass/straw/bamboo/wood/mud

2. live in house with roofs covered with Tali/GI/ Tin/Asbestos and having earthen wall or wall made of un-burnt brick or wood/stone

3. have no source of drinking water near the house

4. do not have any electric connection

5. have no concrete latrine

6. do not have any male member within the age group between 16-59 years and head of the family is a female

7. belong to SC category

8. belong to ST category

9. have no literate adult member

10. do not have any adult member having primary education

11. have one of the members who is handicapped/suffering from prolonged diseases

work as a) Peddler/Cobbler/Hawker b) Construction worker/Plumber/Mason/ Labour/Dyer/ Welder/ Security Guard c) Maid

12. Servant/ Worker/Tailor d) Helper/Transport labour/Driver/Conductor/ Helper of the Driver and Conductor/ Garowan/ Rickshaw
Puller, e) Washer-man/ Chowkider, f)Coolie/Porter
13. Head of my family is a Staff of a shop/Sahayak/Helper/Peon of a small concern/Ardali/Waiter/ Electric
mechanic/Mechanic/Repairing workmen
14. Head of the family works on daily wage or weekly wage

15. has no permanent job & source of income is mainly from Pension/interest and/or rent

16. is a Shelter-less family

17. live in a single room with Kachha wall and Kachha roof

18. live on Destitution or begging / Rag-picking / Sweeping / Scavenging/Gardening

19. do not have income

20. all adult members work on irregular or daily wage basis

21. the Head of the family is minor

22. belong to a family where all members of a family within the age group between 18-60 years are either
handicapped or have been suffering from prolonged diseases
23. belong to a family where all members of a family above 65 years or either handicapped or have been suffering from prolonged
diseases
 Government of West Bengal
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)

Annexure 2: Auto-exclusion Criteria and Deprivation Criteria – Rural

Auto-exclusion Criteria[Tick (√) where applicable]*
(You must not fall under any of the following criteria to be eligible to get a ration card) ration card)

I certify that I / my family Tick

here
1. do not have any motorized two / three / four wheelers / fishing boats (which require registration)
2. do not have mechanized three / four wheeler agricultural equipment such as tractors, harvesters etc.
3. do not have Kisan Credit Card with the credit limit of Rs. 50,000 and above
do not have any member as Government Employee : Gazetted / non-gazetted / Central / State Government
4.
/ PSU government-aided autonomous bodies and local bodies
5. is not a household with non-agricultural enterprise registered with the Government
6. do not have any member in the family earning more than Rs. 15,000 per month
7. do not have any member paying income tax or professional tax
8. is not a household with three or more rooms with all rooms having pucca walls and pucca roof
9. do not own a refrigerator
10. do not own landline phones
11. do not have 2.5 acres or more irrigated land with at least one irrigation equipment
12. do not have 5 acres or more land irrigated for two or more crop seasons

Deprivation Criteria [Tick (√)where applicable]*

(You must fulfil at least one criteria to get a ration card)
I certify that I/my family, Tick
here
1. is a household without shelter
2. is destitute / living on alms
3. is manual scavengers
4. is under Primitive Tribal Groups
5. is legally released bonded labourers
6. is a household with only one room with kucha walls and kucha roof
7. is a household with no adult member between age 16 to 59
8. is a Female headed household with no adult male member between age 16 to 59
9. is a household with _____(number to be given) disabled member(s) and no able bodied adult member
10. belong to SC/ST households
11. is a household with no literate adult above 25 years
12. is a landless household deriving the major part of their income from manual casual labour

DO NOT GIVE ANY WRONG or FALSE INFORMATION or

DETAILS. THIS IS PUNISHABLE UNDER LAW.

Application Dated ____/____/________________ RECEIVED for further processing.