West Bengal Transport Workers Social Security Scheme (Page 2 of 4) in pdf

West Bengal Transport Workers Social Security Scheme Page 2

16. Middle Name: _______________________________

17. Last name*: _________________________________

Permanent Address of Applicant

18. Address Line 1* : ________________________________________________________

19. Address Line 2 : _________________________________________________________

20. Rural / Urban*: ______________________

21. Sub-Division : ________________

22. Block/Municipality/Corporation*: ___________________________________

23. Block/Municipality/Corporation Name* : _____________________________________

24. PIN Code* : _________________

25. Post Office*: _________________________

26. Police Station *: ______________________

27. District*: _______________________

28. State* : ________________________

29. Country : ____________________________

Present Address of Applicant

30. Address Line 1* : ________________________________________________________

31. Address Line 2 : _________________________________________________________

32. Rural / Urban*: ______________________

33. Sub-Division : ________________

34. Block/Municipality/Corporation*: ___________________________________

35. Block/Municipality/Corporation Name* : _____________________________________

36. PIN Code* : _________________

West Bengal Transport Workers Social Security Scheme Page 2