Schedule 3
(Relating to sub-rule (1) of Rule 15)
Senior Citizen Identity Card
Name and surname: …
Citizenship certificate No.: …
Address: District: ……. V.D.C./Municipality: …………
Ward No.: …… Tole/Village: …….
Age: ……………….. Sex: …………..
Exemption and facilities that are available:
Name of husband/wife:…..
Details in the case of staying in a care centre: ……….
Name, surname and contact address of the person who should be contacted:
……..
Blood group and name of disease if any, and name of medicine consumed:…
Certifying official:
Signature:
Name and surname:
Post:
Office: