69 Checklist to Form - A-1a Checklist of documents to be submitted with Application Form for engagement on compassionate ground in respect of individual person Part- I: Application fees * for office use only Submitted (YES/NO) (to be filled by the applicant) * Found (Y/N) (to be filled by the receiving staff) 18. Application fees deposit challan Part- II: Details of the Applicant * for office use only Submitted (YES/NO) (to be filled by the applicant) *Found (Y/N) (to be filled by the receiving staff) 19. Identity proof of the Individual [EPIC(s)/Aadhaar Card(s)/Passport(s)] 20. Proof of residential address of the Individual [Photocopy of EPIC/Aadhaar/Passport /recent Electricity bill/Driving Licence] 21. Proof of date of birth of the Individual [Birth certificate/Admit card of Madhyamik or equivalent/EPIC/Aadhaar Card/Passport/PAN] 22. PAN Card of Individual 23. Proof of educational qualification of individual [Certificate or Marksheet ] 24. Medical certificate of fitness of individual from a Govt. Hospital 25. Family income certificate issued by the local authority Part-III: Details of the deceased/incapacitated dealers * for office use only Submitted(YES/NO) (to be filled by the applicant) *Found (Y/N) (to be filled by the receiving staff 9. Copy of last valid licence in the name of the deceased/incapacitated dealer 10. Photocopy of death certificate of the deceased dealer 11. Legal heirs certificate of the deceased/incapacitated Dealer issued by competent authority and Affidavit from the 1 st