FORM SSS-I S.No______________ APPLICATION FOR FINANCIAL ASSISTANCE UNDER J&K INTEGRATED SOCIAL SECURITY SCHEME-1994 To The District Social Welfare, Leh. District ______________________________ Tehsil _______________________________ Town _______________________________ 1. Name of the applicant _________________________________________ (In block letters) 2. Whether male / female _________________________________________ 3. Name of the Father / Husband ___________________________________ 4. Full postal address 5. Age on date of application (proof of stated age to be enclosed 6. Identification mark ____________________________________________ 7. Status of the applicant (cross irrelevant categories) a. Single Old man / women of 60 / 55 years respectively or above __ __________________________________. b. Old man / women of 66 / 55 year respectively having one or more dependents _____________________________________________. c. Single widow / divorced of 40 year or above ____________________ d. Widow / divorced of 40 year or above having one or more dependents e. Orthopaedically / physically handicapped up to 18 years (Certificate of disability from associate professor or particulars specialist to be enclosed) ________________________________________________. f. Widow / divorsed of 40 year of above __________________________ i) If already trained copy of certificate to be enclosed _____________________________________________. ii) If not trained the specidied sciplire in which interested to have the training ___________________________________. 2. Orthopaedicall/ Physically handicapped above 18 years (certificate if disability from associate professor of particulars specialty to be enclosed) Yes/No i) if already trained (copy of Certificate to be enclosed _________________________________ ii) If not trained specific discipline in which interested to have training_______________________________________________ h) Orphan being victim of militancy (is already studying particulars of School / Class Certificate from the school to be enclosed) i) Brief discription of indiden for cerification purpose _________ PERSONAL AFFIDAVIT I _________________________ D/o S/o Wife of _______________________ Residence of _______________________ do here by affirm that the above particulars furnished by me are correct to the best of my knowledge. Place : -Date : -Signature or thumb impression Of the applicant VERIFICXATION REPORT Specific enquery has been conducted by me and the particulars are furnished by the applicant have been found correct/incorrect. The request of the applicant fails within/do not fail with preview of J&K Integrated social security rule, 1994 According the case of recommended to the District level Committee. Date _______________ Tehsil Social Welfare office (Stamp_____________________) RECOMMENDATION OF COMMITTEE The applicant has been scrutinized and the applicant has been found eligible for grant of monthly / person lump-sum aid in kind of Rs. ____________________ per month / of Rs. __________________________ in lump-sum after completion of job oriented training course successfully. District. Development Commissioner (Stamp _____________________)
