APPLICATION FORM FOR NATIONAL FAMILY BENEFIT SCHEME (NBFS) (Chhungkaw harsa zual chhiat tawk tanpui dilna) 1. Diltu hming(Hawprawppuiin) 2. Kumzat 3. Pa hming 4. Veng/Khua 5. District/P.O 6. Kumkhat chhunga chhungkaw Sum lalkluhzat 7. Diltu eizawnna 8. 1) Chhungkaw eizawngtu ber boralta Hming leh Kum zat 2) Hnathawhthin 3) Thih chhan 4) Tanpui diltu nena inlaichinna : .............. : .............. : .............. : .............. : .............. : .............. : .............. : .............. : .............. : .............. : .............. 9. Chhungkua member zat leh diltu nena inlaichinna Sl No Hming Kum Hnathawh inlaichinna 1. ................................. 2. ................................. 3. ................................. 4. ................................. 5. ................................. Date ...... Diltu Hming CERTIFICATE Pi/Pu ............. hi kan veng/khua a mi ngei a ni a, tanpui tlak a ni in a rawn dilna a a rawn ziah te hi a dik ngei a ni tih kan hriatpui a, diklo leh felhlel awm thei zawng zawngah mawh kan phur ang. Signature of President Signature of VCP YMA with Seal with Seal
