APPLICATION FORM

FOR IDENTITY CARDS TO THE SENIOR   CITIZENS IN THE STATE OF  KARNATAKA

ISSUED BY THE DEPARTMENT OF WELFARE OF DISABLED & SENIOR CITIZENS, GOVT. OF KARNATAKA.

Name & Address of the Association Approved for the issues of ID Cards by Govt of Karnataka.

Senior Citizen Forum CBR NETWORK

#134, 6  Main, 1 Block, 3 Phase, Banashankari 3 Phase, Bangalore – 560085,  Phone : 26724221

TO BE FILLED BY CITIZENS OF KARNATAKA WHO HAVE COMPLETED SIXTY YEARS OF AGE AS ON THE DATE OF FILLING UP OF THE APPLICATION

AS TO APPEAR ON THE CARD – TO BE FILLED BY THE APPLICANT