60 *If surrender application submitted due to death of any family member, please mention date of death. Submission of death registration certificate is mandatory Signature of the Applicant -----------------------------Return this portion to the Applicant------------------------ The application form VII-U for Exclusion of name(s) from NFSA/RKSY Eligible beneficiaries’ List has been received from Shri/Smt………………………., Address……………………………, Ward no…………………. Signature of Authority (with Seal) #Reason for surrender – (1) Death of family member (2) Other reasons. Government of West Bengal Form: VII-R (Application form for exclusion of name from Ration Card NFSA/RKSY Eligible beneficiaries’ List in rural area) [see clause 12B] To The Inspector Food & Supplies, ……………………………………..…. Block, District ……………………………………… Sir, I would like to request you to please exclude My name/ Name of my family member name from Rajya Khadya Suraksha Yojana (RKSY) / National Food Security Act (NFSA) List. Block Gram Panchayet – Enumaration Block No.- NFSA/RKSY card no Card type (AAY/PHH/ SPHH/ RKSY-I/ RKSY-II etc.) Name of Head of the Family Name of the other family member of the family who possesses the card of NFSA / RKSY Reason for exclusion from the NFSA/RKSY *#.