Department of Food, Civil Supplies & Consumer Affairs

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Department of Food, Civil Supplies & Consumer Affairs

Government of Himachal Pradesh

District:_____________________________________ Block:________________________________________

Panchayat:____________________________ Village / Town:________________________________________

New FPS Registra�on Form for ePDS So�ware

Food Instpector Office [Inspector Name]:________________________________________________________

Operated By:______________________________________________________________________________

Lic. / Authority Number:________________________________ Lic. Valid From:_______________________

Lic. Valid To:__________________________________________Shop Type:___________________________Permanent / Temporary

Reserva�on Category:_______________________________________________________________________

FPS Caste Category:__________________________________Godown Name:_________________________

PDC Name:_______________________________________________________________________________

Signature of the Applicant

Ra�on Cards

Popula�on

APL ANTODAYA ANNAPURNA TOTAL

Coop. / Individual / Panchayat / HPSCSC/ Mahila Mandal/ Others

Woman / Handi. / Ex-serviceman / Others

INITIAL RATION CARDS & POPULATION DETAILS

Signature & Seal of the Area Inspector

DISTANCE DETAILS

PUCCA KUCHAPLAIN

BPL

MULE HEAD LOAD CARRIAGE RATE MOTORABLE

General /ST / SC/ Others

FPS Type:____________________________Normal / KeroseneFPS Owner Name:_____________________________________

FPS Owner Permanent Address:_______________________________________________________________

_________________________________________________________________________________________

FPS Status:___________________________

Owner Aadhaar No: Mobile Number:

FPS Shop Name:______________________________________ Ac�ve / Payment Due

SalesMan1

SalesMan2

Mobile Number:DOJName

mm/dd/yyyy

mm/dd/yyyy

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