Form: IX-R (Application form for getting duplicate card against Lost, Damaged and Defaced card)

To
The Inspector Food & Supplies,
... Block, District
Sir,
I would like to inform you that I want to get duplicate digital card/cards , So I am requesting you to please issue duplicate card/cards against following card/cards details of which
mentioned below .
Block - Gram Panchayet Enumaration Block No.- Village Samsad - Village -
Mouza Address- Mobile no. (of any family member) -
*Name as mentioned in the card *Card no. *Type of Card *Please specify, for which reason you are applying Aadhar or EPIC no for any family
(AAY/PHH/ for duplicate Ration card. member to establish identity
SPHH/ Lost/Damaged/Defaced (This number only required if
RKSY-I/ (For lost card you have to submit copy of application made for duplicate
RKSY-II etc.) General Diary mentioning the card no and card against lost card)
category, for damaged and defaced card you
have to submit the card in original)

Document attached (Please tick on sl number)

(1) Copy of General Diary (Where application for duplicate card made against lost card)
(2) Copy of Aadhar card or EPIC card (Where application for duplicate card made against lost card)
(3) Original Digital card (In case of Damaged and defaced card)
___________________
Signature of Applicant

-----------------------------------------------------------------------Return this portion to the Applicant-----------------------------------------------------------------------------------------------------

------------- The application form IX-R has been received from Shri / Smt ., Address,
Village.
__________________________
Signature of Authority (with Seal)