1/17/12 web1.kar.nic.in/rconline/rc_acknowledgement.aspx?ACKID=1018996&TY

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Receip No 1018996ReceipDa e

13/12/2011

Place of Re idence U ban/IRA

Di ic BANGALORE Tal kBANGALORENORTH

CiBANGALORENORTH TOWN

Wa d No 41

Ca d T pe Appl ing Fo Abo e Po e Line

Do o ha e Elec iciConnec ion?

Ye

Di ic / Tal k /ESCOM Ci cleCode

BANGALORE / /

Loca ion Code 1110401 R R No PNLG79998

If o ha e elec ici bill i hano he famil , hen oa e age mon hl ha e in

pee

0

Name of heApplican

Mohan K ma M R

Re idenceAdd e PIN

c/o T M Pand anga pillai,#14 5 h c oRajgopalnaga a Lagge e 560058

Office Add e PIN 0

Landma kBehind Rajgopal naga police

a ion

Since ho man eao a e e iding in he

add e ?2.00

LandLinePhone No

0 Mobile No 9845309917

Da e of Bi h(dd/mm/ )

16/08/1983 Yea of Bi h ( ) 1983

Gende Male Aadha No

E - mail Emplo menPRIVATEEMPLOYEE

Re idenceT pe

Ren / Lea e / O he Ren Amo n (in R .) 1500

Ma i al S a Single

Add e ofPa en /Famil

c/o T M Pand anga pillai, #14 5 h c o Rajgopalnaga a Lagge eBangalo e 560058

Famil Membe De ail

NameDate of Birth

(dd/mm/ )

Year ofBirth

( )Gender Relation Emplo ment

AadharNo

Ki anM R

02/10/1987 1987 MaleYo ngeB o he

PRIVATEEMPLOYEE

O he De ail

To al Ann al Income of he Famil (f om allo ce ) (in R .)

15000Income Ta Pan Ca dNo

LPG connec ion i a ailable? NoDo o needLPGConnec ion?

No

Rea on o Appl fo Ra ion Ca d No Ra ion Ca d fo m Famil

Rema k

1/17/12 web1.kar.nic.in/rconline/rc_acknowledgement.aspx?ACKID=1018996&TY

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) . 2.00 .

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) 15000 .

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: 13/12/2011

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