FORM -III Application Form for the Registration of the Members of a Family under Prime Minister Employment Guarantee Scheme State Code/District Code/Block Code/Panchayat Code/Village/Family Members. 2. Name of the applicant __________________________________________ 3. SC/ST/IAY/LR beneficiary _______________________________________ 4. Details of the applicants of the Household willing to work 5. Address _____________________________________________________________ 6. Date of Registration :___________________________________________________ S.No. Name Father's/Husband's name Male/Female Photograph(s) of members of Household willing to work, duly attested by Sarpanch and Panchayat Secretary. Signature/Thumb impression of applicants. Seal & Signature of Registration Officer.
