Application for Residence Certificate

    [md-form]

    [md-text label="Applicant Full Name"]

    [/md-text]

    [md-text label="Profession/Occupation"]

    [/md-text]

    [md-text label="Name of head of the household in
    which the applicant resides"]

    [/md-text]

    [md-text label="Place of Residence"]

    [/md-text]

    [md-text label="House No."]

    [/md-text]

    [md-textarea label="Wado/Street/Village etc"]

    [/md-textarea]

    [md-text label="Name of Village Panchayat"]

    [/md-text]

    [md-text label="The Period of residence or since when
    the applicant residing at the above
    referred place"]

    [/md-text]

    [md-text label="The place of residence prior in the place
    of resident as indicated above, in case
    the applicant was not staying
    continuously at the above given address"]

    [/md-text]


    [md-radio label="What you doing during last 6 months" display="inline"]
    UnemployedEmployedBusinessStudent
    [/md-radio]

    [md-text label="Where You Employed During Last 6 Months"]

    [/md-text]
    [md-text label="what type of business indulge during Last 6 Months"]

    [/md-text]
    [md-text label="Name of School/Organisation/institution"]

    [/md-text]

    [md-text label="Relationship of the applicant with the
    head of household with whom she/he
    resides:"]

    [/md-text]

    [md-text label="Whether the applicant’s name included
    In the ration card of this taluka and the
    Electoral roll in the affirmative indicate
    ration card no. and since when it is
    included:"]

    [/md-text]

    [md-textarea label="Whether the applicant has any
    Immovable Property or share in the
    place of residence And if so, give
    details"]

    [/md-textarea]

    [md-text label="Purpose for which the residence
    Certificate is required and before whom
    it is to be produced:"]

    [/md-text]

    [md-submit]

    [/md-submit]

    [/md-form]