A B C D E F G H 1 FORMA T B - REQUIR ED INFORM ATION OF BENEFI CIARY (Part A) 2 Sex [Male: 01, Female: 02] 4 House No. Name of the Slum City Mobile No. 5 1 2 3 4 5 6 7 8 6 7 8 9 10 11 12 3 S. No. Name of head of the family Father’s name Present Address and Contact Details
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A B C D E F G H
1
FORMA
T B -
REQUIR
ED
INFORM
ATION
OF
BENEFI
CIARY
(Part A)
2
Sex
[Male: 01,
Female:
02]
4 House No.
Name of
the Slum City Mobile No.
5 1 2 3 4 5 6 7 86
7
8
9
10
11
12
3
S. No.
Name of
head of
the family
Father’s
name
Present Address and Contact Details
13
14
Note :
Please
enter the
specified
code in
column
3,22 &
23. For
example
in
column 3
please
enter 1
for male,
2 for
female &
3 for
transgen
der
List
A B C D E F G H
1
2
Sex
3
S. No.
Name of
head of
the family
Father’s
(Husband
's) name
Present Address and Contact Details
[Male: 01,
Female:
02]
4 House No.
Name of
the Street Ward City
5 1 2 3 4 5 6
Ward
No. 7
6 1
MEENA
DEVI 2
TAPESH
WAR
PANDEY 154
SAHANA
ROAD 1
KODERM
A
7 2
DEEPAK
KR RAM 2
LATE
BABU LAL
RAM
MAHAVE
ER
MUHALL
A 8
KODERM
A
8 3
BABY
DEVI 2
MUKESH
RAM 39
MAHAVE
ER
MUHALL
A 8
KODERM
A
9 4
VIMLA
DEVI 2
PARDEEP
KUMAR
RAM 88
MAHAVE
ER
MUHALL
A 8
KODERM
A
10 5
BIRJU
RAVIDAS 1
LATE
MEGHAN
DAS 45
BARSOTI
YABAR 15
KODERM
A
11 6
MUNNU
DEVI 2
CHHOTU
DAS 78
BARSOTI
YABAR 15
KODERM
A
3
S. No.
Name of
head of
the family
Father’s
(Husband
's) name
Present Address and Contact Details
12 7
URMILA
DEVI 2
RAVINDR
A NATH
GOSWA
MI
ADARSH
MUHALL
A 8
KODERM
A
13 8
CHETNI
DEVI 2
LATE
BABUL
RANA 113
GRIDIH
ROAD
KODERM
A
14 9
ASHA
DEVI 2
VIRENDR
A KR
RAM 89
MAHAVE
ER
MUHALL
A 8
KODERM
A
15 10
PARBHU
RAM 1
LATE
JAGDISH
RAM
MAHAVE
ER
MUHALL
A 8
KODERM
A
16 11
KANCHA
N DEVI 2
NIRMAL
PASWAN 52
JALWABA
D 7
KODERM
A
17 12
SAIRUN
KHATOO
N(PH) 2
ABDUL
QUAYUM 62
JALWABA
D 7
KODERM
A
18 13
ISHRAT
PARVEEN
(PH) 2
MANZOO
R ALAM 33
GRIDIH
ROAD 7
KODERM
A
19 14
SANJIDA
KHATOO
N 2
MD
IRSHAD 68
JALWABA
D 7
KODERM
A
20 15
AAJO
KHATOO
N(PH) 2
MD
YASEEN 42
JALWABA
D 7
KODERM
A
21 16
KORESHA
KHATOO
N 2
LATE ALI
BAKSH 59
JALWABA
D 7
KODERM
A
22 17
SHIV
SHANKAR
RAM 1
LT
NAYANC
HAND
RAM 37
MAHAVE
ER
MUHALL
A 8
KODERM
A
23 18
KISHUN
PR SINGH 1
LT-
HARDYAL
SINGH 37
MAHAVE
ER
MUHALL
A 8
KODERM
A
24 19
REKHA
DEVI 2
DASHRAT
H RAM 14A
MAHAVE
ER
MUHALL
A 8
KODERM
A
25 20
PUNAM
DEVI 2
VINOD
RAM 22
MAHAVE
ER
MUHALL
A 8
KODERM
A
26 21
UJWAL
KR
GHOSH 1
LT-
NARAYA
N
RANJAN 65
MAHAVE
ER
MUHALL
A 8
KODERM
A
27 22
KANCHA
N DEVI 2
UMA
SHANKAR
DHOBI 114
DARJI
CHAOWK 12
KODERM
A
28 23
ASGARI
KHATOO
N 2
MD
HALIM 61
DARJI
CHAOWK 12
KODERM
A
29 24
RUBEDA
KHATOO
N 2
ABDUL
RAHIM 62
DARJI
CHAOWK 12
KODERM
A
30 25
JAMILA
KHATOO
N 2
MD
SABIR 72
DARJI
CHAOWK 12
KODERM
A
31 26
ANWARI
KHATOO
N 2
MD
FIROZ 59
DARJI
CHAOWK 12
KODERM
A
32 27
MD
IRFAN 1
LT-
RAMZAN 105
DARJI
CHAOWK 12
KODERM
A
33 28
MD
FAIYAZ
ALAM 1
IMTIYAZ
AHMAD 85
JALWABA
D 2
KODERM
A
34 29
SARFARA
Z 1
LT-
MOJIB
MIYAN
JALWABA
D 2
KODERM
A
35 30
AJMERI
KHATOO
N 2
MD
USMAN
ANSARI
JALWABA
D 2
KODERM
A
36 31
MEHRUN
NISHA 2
LT- ALIM
MIYAN 45
JALWABA
D 2
KODERM
A
37 32
KANCHA
N DEVI 2
PARDEEP
DAS 23
BAHERW
ATAND 2
KODERM
A
38 33
SHIVA
DEVI 2
BACHHU
CHOUDRI 78
BARSOTI
YABAR 15
KODERM
A
39 34 SITA DEVI 2
MAHESH
DAS 44
BARSOTI
YABAR 15
KODERM
A
40 35
SHANTI
DEVI 2
BHOLA
DAS 50
BARSOTI
YABAR 15
KODERM
A
41 36
BHAGIYA
DEVI 2 MOJI DAS 78
BARSOTI
YABAR 15
KODERM
A
42 37
DULARI
DEVI 2
DOMI
DAS 112
BARSOTI
YABAR 15
KODERM
A
43 38
BASANTI
DEVI 2
SHANKAR
DAS 82
BARSOTI
YABAR 15
KODERM
A
44 39
BIRENDR
A SINGH 1
LT- LOHRI
SINGH 139
DUDHIM
ATI 13
KODERM
A
45 40
AHLIYA
DEVI 2
LT-
SUKHDEV
PANDEY 119
LAKHIBA
GHI 13
KODERM
A
46 41
MANOJ
PANDEY 1
SUKHDEV
PANDEY 119
LAKHIBA
GHI 13
KODERM
A
47 42
POKHRAJ
PANDEY 1
LT- RAM
SAHAY
PANDE 124
LAKHIBA
GHI 13
KODERM
A
48 43
SITA
RAM
THAKUR 1
LT-
PRAMES
HWAR 99
LAKHIBA
GHI 13
KODERM
A
49 44
LATO
PANDEY 1
LT-
BAIJNAT
H
PANDEY 131
LAKHIBA
GHI 13
KODERM
A
50 45
SUNITA
DEVI 2
SANJAY
KUMAR 75
SHIV
MUHALL
A 9
KODERM
A
51 46
KISHOR
RAVIDAS 1
ANUP
RAVIDAS 84
SHIV
MUHALL
A 9
KODERM
A
52 47
CHINTAM
AN DAS 1
GOBHI
DAS 90
SHIV
MUHALL
A 9
KODERM
A
53 48
ROHAN
DAS 1
ASHO
DAS 95
SHIV
MUHALL
A 9
KODERM
A
54 49
RAJENDR
A DAS 1
LT-
SOMAR
DAS 88
SHIV
MUHALL
A 9
KODERM
A
55 50
BANSI
DAS 1
LT- GURA
DAS 125
SHIV
MUHALL
A 9
KODERM
A
56 51
MAHESH
YADAV 1
JAGO
YADAV
BADKIBA
GHI 11
KODERM
A
57 52
GITA
DEVI 2
DASHRAT
H RAM 144
LAKHIBA
GHI 11
KODERM
A
58 53
MUNNI
DEVI 2
VIJAY
RAM 144
LAKHIBA
GHI 11
KODERM
A
59 54
GUDIYA
DEVI 2
RAJESH
YADAV
BADKIBA
GHI 11
KODERM
A
60 55
MOHAN
YADAV 1
CHINTAM
ANI
YADAV 22
BADKIBA
GHI 11
KODERM
A
61 56
SHABAN
A
PARVEEN 2
IMRAN
ALAM 15
JALWABA
D 5
KODERM
A
62 57
NAJBEEN
BANO 2
NISAR
AHMAD 62
JALWABA
D 5
KODERM
A
63 58
SALEHA
KHATOO
N 2
MD
AZHAR
HUSSAIN 138
JALWABA
D 5
KODERM
A
64 59
ASGARI
KHATOO
N 2
MERAJ
ALAM 136
JALWABA
D 5
KODERM
A
65 60
JAMIRUL
HAQUE 1
MD
RAFIK 83
JALWABA
D 5
KODERM
A
66 61
RABIYA
KHATOO
N 2
NEYAZ
AHMAD 65
JALWABA
D 5
KODERM
A
67 62
RAM
LAKHAN
DAS (PH) 1
LT- JARI
DAS 93
BAHERW
ATAND 3
KODERM
A
68 63
SUNAINA
DEVI 2
KARU
SAW 150
BAHERW
ATAND 3
KODERM
A
69 64
USMA
DEVI 2
MANOJ
SAW 165
BAHERW
ATAND 3
KODERM
A
70 65
ISRAT
KHATOO
N 2
MD
ZAHID
ALI
NAGARK
HARA 3
KODERM
A
71 66
BASANTI
DEVI 2
KEDAR
SAW 164
BAHERW
ATAND 3
KODERM
A
72 67
AMNA
KHATOO
N 2
IBRAHIM
MIYAN 104
BAHERW
ATAND 3
KODERM
A
73 68
VINOD
SINGH 1
JAGMOH
AN
SINGH 196
DUMARIY
ATAND 1
KODERM
A
74 69
MANJU
DEVI 2
RAM
PUKAR
RAY
CHHOTKI
BAGKI 1
KODERM
A
75 70
GANGIYA
DEVI 2
VIJAY
SINGH 209
DUMARIY
ATAND 1
KODERM
A
76 71
B ISNI
DEVI 2
LT- PATI
SINGH 68
DUMARIY
ATAND 1
KODERM
A
77 72
CHURAW
AN
SINGH 1
LT-
BANDHA
N SINGH 64
DUMARIY
ATAND 1
KODERM
A
78 73
MD
SAJUD
AKHTER 1
LT- SERAJ
UDDIN 81
JALWABA
D 2
KODERM
A
79 74
ISHRAT
JAHAN 2 MD ASIF
JALWABA
D 4
KODERM
A
80 75
GULSHA
N ARA 2
SAMSUD
DIN 21
NAGARK
HARA 4
KODERM
A
81 76
DEEPA
DEVI 2
CHHOTU
VISKARM
A 458
NAGARK
HARA 4
KODERM
A
82 77
NAJRA
BANO 2
HABIBUL
RAHMAN 75
NAGARK
HARA 4
KODERM
A
83 78
PAKIJA
KHATOO
N 2
SERAJ
UDDIN 535
NAGARK
HARA 4
KODERM
A
84 79
AMIT KR
SRIWAST
AW 1
ANIL PR
SRIWAST
AV 283
SAHANA
ROAD 10
KODERM
A
85 80
SONIYA
DEVI 2
UMESH
DAS 123
NIMA
TOLI 10
KODERM
A
86 81
MANJU
DEVI 2
RAM DEV
RAM 134
NIMA
TOLI 10
KODERM
A
87 82
ANITA
DEVI 2
MAHESH
DAS 133
NIMA
TOLI 10
KODERM
A
88 83
MANISH
KR
PANDEY 1
CHHOTE
LAL
PANDEY 109 KOLTEX 10
KODERM
A
89 84
SUMAN
BHARTI 2
RANDHE
ER SINGH 36
CHHOTKI
BAGI 14
KODERM
A
90 85
SANJU
DEVI 2
KELU
YADAV 4
NEAR
BIJLI
OFFICE 14
KODERM
A
91 86
MALA
MASOM
AT 2
LT-
PARYAG
PANDEY
BAJRANG
NAGAR 14
KODERM
A
92 87
ARJUN
RAM 1
BUDHU
RAM KOLTEX 14
KODERM
A
93 88
MANTI
MASOM
AT 2
LT- RAM
KISHUN
RAM KOLTEX 14
KODERM
A
94 89
CHANDO
DEVI 2
LT-
BUDHAN
SINGH 125
SUNDER
NAGAR 6
KODERM
A
95 90
NUTAN
DEVI 2
RUPLAL
RAVIDAS
RAVIDAS
TOLA 6
KODERM
A
96 91
ANITA
DEVI 2
BALDEV
RAM
MAHAVE
ER
MUHALL
A 6
KODERM
A
97 92
RENU
DEVI 2
JALDHARI
RAVIDAS
HARIJAN
MUHALL
A 6
KODERM
A
98 93
RATAN
LAL 1
LT-
JAGDISH
RAM
MAHAVE
ER
MUHALL
A 6
KODERM
A
99 94
REENA
DEVI 2
MOHAN
RAVIDAS
RAVIDAS
TOLA 6
KODERM
A
I J K L M N O P Q
Ownershi
p details
of
existing
house
Type of
the house
based on
roof type
[Own – 01,
Rent – 02,
Otherwise
– 03]
[Pucca
(CC &
Stone
Slab)-01,
Semi-
Pucca
(Asbestos/
Steel
Sheet,
Tiled)-02,
House/ Flat/ Door
No
Name of
the Street
City/
Village District State
Katcha
(Grass/tha
tched,
Tarpaulin,
Wooden)-
03]
9 10 11 12 13 14 15 16 14
Number
of rooms
in the
dwelling
unit
excluding
kitchen
Aadhaar
Card
Number
Permanent Address
I J K L M N O P Q
Ownershi
p details
of
existing
house
Type of
the house
based on
roof type Religion Caste
Number
of Years
of Stay in
this
Town/City
Present Address and Contact Details
Aadhaar
Card
Number
If
Aadhaar
Card
Number
is not
available
then
Voter ID
Card/Any
other
unique
identificat
ion
number
Whether the family owns any
house/ residential land
anywhere in India
[Own – 01,
Rent – 02,
Otherwise
– 03]
[Pucca
(CC &
Stone
Slab)-01,
Semi-
Pucca
(Asbestos/
Steel
Sheet,
Tiled)-02,
[Hindu-01,
Muslim-
02,
Christian-
03, Sikh-
04,
Jainism-
05,
Buddhism-
06,
Zoroastria
nism-07,
others
(specify)]
[General-
01, SC-02,
ST-03,
OBC-04]
[0 to 1
year -01, 1
to 3 years-
02, 3 to 5
years- 03,
More than
5 years-
04]
Mobile No.
Katcha
(Grass/tha
tched,
Tarpaulin,
Wooden)-
03] (Yes/No)
8 9 10 11 12 13 14 15 16
7870313055 1 3 1 1 4 YES
8873547886 1 3 1 4 4 YES
9006763271 1 2 1 1 4
8409619374 3 3 1 4 4 YES
8292936633 1 3 1 2 4 YES
9973369675 1 3 1 2 4 YES
Present Address and Contact Details
Aadhaar
Card
Number
If
Aadhaar
Card
Number
is not
available
then
Voter ID
Card/Any
other
unique
identificat
ion
number
Whether the family owns any
house/ residential land
anywhere in India
9546371739 1 3 1 4 4 YES
8603788625 1 2 1 4 4 YES
9431399731 1 3 1 4 4 YES
9771355299 1 3 1 4 4 YES
9060416334 1 3 1 2 4 YES
8809215731 1 3 2 4 4 YES
8409449632 1 3 2 4 4 YES
9798730257 1 2 2 4 4 YES
9570176090 1 2 2 4 4 YES
9835808885 1 3 2 4 4 YES
9122863043 2 1 1 4 4 YES
9155677839 1 3 1 4 4 YES
9801919060 1 2
KFR6783
716 1 4 4 YES
8809142755 3 3 1 4 4 YES
7870170009 1 3 1 4 4 YES
8292422756 1 3 1 2 4 YES
953404681 1 3 2 4 4 YES
9939857304 1 3 2 4 4 YES
7766003394 1 3 2 4 4 YES
8540867759 1 3 2 4 4 yes
9631413696 1 3 2 4 4 YES
9102391505 1 3 2 4 4 YES
7250937791 1 3 2 4 4 YES
7763830470 1 3 2 4 4 YES
9939574590 1 3 2 4 4 YES
7739371955 1 3 2 4 4 YES
7763973633 1 3 1 2 4 YES
7808119764 1 3 1 2 4 YES
7763973633 1 3 1 2 4 YES
7070327395 1 3 1 2 4 YES
8271122498 1 3 1 2 4 YES
8294960803 1 3 1 2 4 YES
8228015400 1 3 1 1 4 YES
9955628880 1 3 1 1 4 YES
9973492039 3 3 1 1 4 YES
95761582590 1 3 1 1 4 YES
9934537053 1 3 1 4 4 YES
9631477820 1 3 1 1 4 YES
9122596892 1 3 1 1 4 YES
9199177563 1 3 1 4 4 YES
8969931166 1 3 1 3 4 YES
8674841163 1 3 1 3 4 YES
8294076364 1 3 1 2 4 YES
8271733594 1 3 1 2 4 YES
8809655593 1 3 1 4 4 YES
8862930136 1 3 1 4 4 YES
7050617263 3 3 1 4 4 YES
9155380054 3 3 1 4 4 YES
9955657891 3 3 1 4 4 YES
9852080525 3 3 2 4 4 YES
8521798928 1 3 2 4 4 YES
8083756729 1 3 2 4 4 YES
7050995176 1 3 2 2 4 YES
8002255866 1 3 2 4 4 YES
9155403543 1 3 2 4 4 YES
9709133260 1 3 1 2 4 YES
8541858369 1 3 1 4 4 YES
9661449284 1 3 1 4 4 YES
8084806868 2 1 2 4 4 YES
9960125564 1 2 1 4 4 YES
9771357097 1 3 2 4 4 YES
9661458914 1 3 1 3 4 YES
8651172405 1 3 1 4 4 YES
8809086579 1 3 1 3 4 YES
7762805491 1 3 1 3 4 YES
80021546398 1 3 1 3 4 YES
7677503321 1 3 2 4 4 YES
8651287733 1 3 2 4 4 YES
8797664404 2 3 2 4 4 YES
7277003106 1 3 1 4 4 YES
9576462372 2 3 2 4 4 YES
9122178383 1 3 2 4 4 YES
7033333165 1 3 1 1 4 YES
9934766098 1 3 1 2 4 YES
7294878490 1 3 1 1 4 YES
7763829916 1 3 1 2 4 YES
9708100163 2 3 1 1 4 YES
7654588021 1 2 1 1 4 YES
8292937776 2 3 1 4 4 YES
9122173429 2 1 1 1 4 YES
8292409119 1 3 1 4 4 YES
8862939381 1 3 1 4 4 YES
9955614953 1 3 1 4 4 YES
1 3 1 2 4 YES
8409476293 1 3 1 4 4 YES
8651771482 1 3 1 2 4 YES
1 3 1 4 4 YES
843160629452 1 2 1 2 4 YES
R S T U V W X Y Z
FORMA
T B -
REQUIR
ED
INFORM
ATION
OF
BENEFI
CIARY
(Part B)
Religion Caste
[Hindu-01,
Muslim-
02,
Christian-
03, Sikh-
04,
Jainism-
05,
Buddhism-
06,
Zoroastria
nism-07,
others
(specify)]
[General-
01, SC-02,
ST-03,
OBC-04]
Relationship
to Head of
the Family Gender Age
Aadhaar
Card
Number
Voter ID
Card/Any
other
unique
identificat
ion
number
18 19 20 21 22 23 24 25 26
If
Aadhaar
Card
Number
is not
available
then EID
number
Voter ID
Card/Any
other
unique
identificat
ion
number
Number & age of family members
R S T U V
Employm
ent
Status
Housing
requirem
ent of
family
Whether the family owns any
house/ residential land
anywhere in India
Average
monthly
income of
househol
d (in Rs.)
(Self
Employed
– 01,
Salaried –
02,
Regular
Wage –
03,
(New
House –
01,
Enhancem
ent – 02)
If yes,
then
location
details
(Locality/
City/
State)
If yes,
then
extent of
land in
sq.mtrs
Labour –
04, Other
– 05)
17 18 19 20 21GANDHI
CHOWK
SAHANA
ROAD 40.5 5 2000 1MAHAVE
ER
MUHALL
A 91 4 4000 1MAHAVE
ER
MUHALL
A 641 4 4862 1MAHAVE
ER
MUHALL
A 91 4 3000 1
BARSOTI
YABAR 91 5 1500 1BARSOTI
YABAR 45 5 1500 1
Whether the family owns any
house/ residential land
anywhere in India
Average
monthly
income of
househol
d (in Rs.)
ADARSH
MUHALL
A 91 3 3000 1
GRIDIH
ROAD 91 3 5000 1MAHAVE
ER
MUHALL
A 121.5 1 5000 1MAHAVE
ER
MUHALL
A 700 1 4000 1JALWABA
D 91 3 2000 1
JALWABA
D 91 4 2000 1
GRIDIH
ROAD 91 4 3000 1
JALWABA
D 121.5 4 3000 1
JALWABA
D 202.5 5 5000 1
JALWABA
D 40.5 5 2000 1MAHAVE
ER
MUHALL
A 91 4 4000 1MAHAVE
ER
MUHALL
A 91 4 4000 1
MAHAVE
ER
MUHALL
A 91 3 4000 1MAHAVE
ER
MUHALL
A 121.5 4 4000 1MAHAVE
ER
MUHALL
A 182 5 4000 1
DARJI
CHOWK 91 4 2500 1
DARJI
CHOWK 91 5 2000 1
DARJI
CHOWK 91 5 2500 1
DARJI
CHOWK 91 5 2000 1
DARJI
CHOWK 91 4 3000 1
DARJI
CHOWK 91 4 3000 1
JALWABA
D 91 1 3000 1
JALWABA
D 202.5 2 3000 1
JALWABA
D 91 4 2500 1JALWABA
D 91 5 3000 1
BAHERW
ATAND 91 5 3000 1
BARSOTI
YABAR 91 1 1000 1BARSOTI
YABAR 91 4 2000 1BARSOTI
YABAR 121.5 1 2000 1BARSOTI
YABAR 91 5 1000 1BARSOTI
YABAR 91 5 1000 1BARSOTI
YABAR 20.5 5 1500 1
DUDHIM
ATI 121.5 4 5000 1
LAKHIBA
GHI 250 4 3000 1
LAKHIBA
GHI 121.5 4 4000 1
LAKHIBA
GHI 182 5 2083 1
LAKHIBA
GHI 121.5 1 4000 1
LAKHIBA
GHI 121.5 4 4000 1SHIV
MUHALL
A 91 4 2500 1SHIV
MUHALL
A 91 3 4590 1SHIV
MUHALL
A 91 4 4000 2
SHIV
MUHALL
A 91 4 4000 1SHIV
MUHALL
A 91 4 4000 1SHIV
MUHALL
A 91 4 4000 1BADKIBA
GHI 91 4 2500 1LAKHIBA
GHI 121.5 4 1501 1LAKHIBA
GHI 121.5 4 4000 1BADKIBA
GHI 182 4 3000 1
BADKIBA
GHI 182 1 4000 1
JALWABA
D 91 1 3000 1JALWABA
D 91 4 3000 1
JALWABA
D 91 5 3000 1
JALWABA
D 121.5 5 2500 1JALWABA
D 91 4 4000 1
JALWABA
D 91 4 3000 1
BAHERW
ATAND 121.5 1 2500 1
BAHERW
ATAND 182 1 2500 1
BAHERW
ATAND 249 4 2500 1
NAGARK
HARA 121.5 1 4000 1
BAHERW
ATAND 200 1 2500 1
BAHERW
ATAND 240 1 2500 1
DUMARIY
ATAND 91 5 3000 1
CHHOTKI
BAGKI 40 4 3500 1DUMARIY
ATAND 40.5 5 3000 1DUMARIY
ATAND 91 5 2000 1
DUMARIY
ATAND 121.5 5 3000
JALWABA
D 40.5 4 3000 1JALWABA
D 121.5 5 3000 1NAGARK
HARA 121.5 4 3000 1
NAGARK
HARA 61 3 3000 1
NAGARK
HARA 121.5 4 3000 1
NAGARK
HARA 121.5 4 3000 1
SAHANA
ROAD 91 4 4800 1NIMA
TOLA 90 4 3500 1
NIMA
TOLA 220 4 4000 1NIMA
TOLA 91 4 4000 1
BARSOTI
YABAR 182 1 4000 1
CHHOTKI
BAGI 202.5 3 4000 1
PURNA
NAGAR 40.5 1 2500 1
BAJRANG
NAGAR 60 1 2000 2
KOLTEX 121.5 4 4168 1
KOLTEX 121.5 1 2000 1
SUNDER
NAGAR 91 4 2000 1RAVIDAS
TOLA 182 4 3000 1MAHAVE
ER
MUHALL
A 182 4 5000 1
RAVIDAS
TOLA 121.5 4 4000 1MAHAVE
ER
MUHALL
A 182 4 2083 1
RAVIDAS
TOLA 121.5 4 5000 1
AA AB AC AD AE AF AG AH AI
Number
of Years
of Stay in
this
Town/City
Employm
ent
Status
[0 to 1
year -01, 1
to 3 years-
02, 3 to 5
years- 03,
More than
5 years-
04]
(Self
Employed
– 01,
Salaried –
02,
Regular
Wage –
03,
Bank
account
number
Name of
the Bank
& Branch (Yes/No)
If yes,
then
location
details
(Locality/
City/
State)
If yes,
then
extent of
land in
sq.mtrs
Labour –
04, Other
– 05)
27 28 29 30 31 32 33 34 35
15. Size of
existing
dwelling
unit (Carp
et area in
square
meters)
Whether the family owns any
house/ residential land
anywhere in India
Average
monthly
income of
househol
d (in Rs.)
Bank
Details
AJ AK AL AM AN AO AP
Housing
requirem
ent of
family
(New
House –
01,
Enhancem
ent – 02)
(Yes /
No)
If yes,
Provide
BPL Card
No
Credit
linked
subsidy -
01
Affordable
Housing in
Partnershi
p - 02
Self
constructi
on - 03
36 37 38 39 40 41 42
Preferred component of
Mission under which
beneficiary need assistance
under HFA
Does the family have
a BPL Card
In case of
enhance
ment,
please
specify
enhance
ment
required [One
room/Kitchen/
Bath/Toilet or
combination
of these]
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