Welcome to Backward Classes Welfare Department

Applied For EWS: *

State

Central

1. Application to:

State : *

West Bengal

District *

Sub-Division *

Municipality

Block

GP/Ward *

2. Application For: *

3. Name: *

4. Father's Name: *

5. Mobile:

6. Email:

7. Documents Required(Atleast One) *

A. Aadhaar No.:

B.(i)Khadya sathi Category:

B.(ii) Khadya sathi No:

8.(A) Date of Birth *

(B) Place of Birth *

District *

Police Station *

Village/Town *

9. Address:

a) Present Address for Last 6 Months:

C/O (Name):

State: *

District: *

Police Station: *

Ward/GP: *

Vill/Para/House No./Road: *

Post Office: *

Pin Code:

b) Permanent Address:

Same as Present?

Yes

No

C/O (Name):

State: *

District: *

Police Station: *

Ward/GP: *

Vill/Para/House No./Road: *

Post Office:

Pin Code:

Any more?

Yes

No

10. Nationality : * INDIAN

11. Religion:*

12.Gender:*

13. Details of two(2) local referees:

a) Name of Referee-I: *

b) Address of Referee-I: *

.

c) Name of Referee-II: *

d) Address of Referee-II: *

14. Whether the applicant or his family migrated from other State/Country?

Yes

No

Domicile status in West Bengal (in years) :

Address in his/her State of origin :

Country:

State:

District:

Police Station:

Village/Ward:

Year of migration:

15.Photo Upload(Size within 100kb in *.jpg format): *

16.Income Tax return: *

YES

NO

17.INCOME AND ASSET DETAILS *

Family Members	Pan Number	Salary	Business	Agriculture	Profession	Other Sources	Total
Self
Father
Mother
Spouse
Siblings

Childrens

Total

Family Members	Area(in acres)	Location
Self
Father
Mother
Spouse
Siblings

Childrens

Total

Family Members	Area(Sq.ft)	Location
Self
Father
Mother
Spouse
Siblings

Childrens

Total

Family Members	Area(Sq.Yards)	Location
Self
Father
Mother
Spouse
Siblings

Childrens

Total

Family Members	Area(sq.yards)	Location
Self
Father
Mother
Spouse
Siblings

Childrens

Total

Government of West Bengal

Backward Classes Welfare Department

Application form for EWS Certificate