(Application Form for issue of Identity card to Senior citizen of Himachal Pradesh) 1. Name ________________________________ 2. Father's Name ________________________________ 3. Full Address Village _______________________________ P.O. ____________________________ Tehsil________________________Distt. Shimla 4. Age _________________________________ (Attach document giving proof of age Matriculation certificate, Certificate by Panchayat Secretary & Municipal Secretary) 5. Height ________________________________ 6. Visible distinguishing Marks________________________ 7. Are you domicile of H.P. _________________________ (Certificate to be attached) 8. Occupation ______________________________ Contact No. (if any) _____________________________ Dated___________ (Signature or Thumb impression of the applicant) Note: (1) Only Himachali can apply (Domicile certificate to be attached while applying) (2) Can be obtained by physically coming to the District Welfare Office as online photo from web camera is captured) (3) Minimum of 60 yrs age (Age proof document to be attached)
