FORM OF APPLICATIN FOR CLAIMING FAMILY BENEFIT (FB) UNDER NSAP
PART 1
(To be filled in by the head of the surviving family).
District ---------------------------- -----Mandal/Municipality ------------------------- Village Gram Panchayat/Ward H.No.----------------------.
1. Name of the applicant Sri/Smt.
2. Full Address
3. Name of the deceased Primary bread winner.
4. Relationship of the deceased with the applicant
5. Date of death of primary
Bread Winner.
6. I solemnly affirm that
a. I do not have any family income of Rs.------ per --- or More
b. I am the surviving head of the family of the deceased primary bread winner
The primary bread winner died at the age of -------- (proof like “Death Certificate “ to be attached)
The deceased was resident of ------------ District where he had been residing for last 3 years immediately preceeding the death.
I declare that the information furnished in the application is true and correct to the best of my knowledge and belief
Place :
Date:
SIGNATURE OF APPLICANT.
PART 1
(To be filled in by the head of the surviving family).
District ---------------------------- -----Mandal/Municipality ------------------------- Village Gram Panchayat/Ward H.No.----------------------.
1. Name of the applicant Sri/Smt.
2. Full Address
3. Name of the deceased Primary bread winner.
4. Relationship of the deceased with the applicant
5. Date of death of primary
Bread Winner.
6. I solemnly affirm that
a. I do not have any family income of Rs.------ per --- or More
b. I am the surviving head of the family of the deceased primary bread winner
The primary bread winner died at the age of -------- (proof like “Death Certificate “ to be attached)
The deceased was resident of ------------ District where he had been residing for last 3 years immediately preceeding the death.
I declare that the information furnished in the application is true and correct to the best of my knowledge and belief
Place :
Date:
SIGNATURE OF APPLICANT.
కామెంట్లు లేవు:
కామెంట్ను పోస్ట్ చేయండి