55 Block - Gram Panchayet – Enumaration Block No.- Village Samsad - Village - Mouza – Mobile no. (of any family member) - Name as recorded in the card at present Card no. Type of Card (AAY/PHH/ SPHH/ RKSY-I/ RKSY-II etc.) Name that requires to be recorded after correction Father’s or Husband’s Name that requires to be recorded after correction Address that requires to be recorded after correction I /We submit the following documents (s) for correction of name / father’s name / husband’s name / address. Birth Certificate/ Aadhaar Card/ Voter ID Card/ MGNREGA Card/ Kishan Credit Card/ Photocopy of the first page of Bank Pass Book/ Photocopy of the Driving Licence/ Photocopy of Passport/ Ration card issued before January 2016 ____________________ Signature of Applicant ------------------------------------Return this portion to the Applicant---------------------- The application form V-R for Correction of Name & Address for one or more than one member of the already included families under NFSA/RKSY has been received from Shri / Smt.…………., Address…………………………………………, Village. …………………. Signature of Authority (with Seal) Government of West Bengal Form: VI-U (Application form for Change of Ration Shop (FPS) in respect of families already Included in NFSA/RKSY eligible family List) (Please fill PART-I or PART-II or PART-III whichever is applicable) [see clause 12A] To Sub Divisional Controller Food &Supplies …………………., / Rationing Officer,……………….………………… District -