APPLICATION FOR GRANTS FROM WELFARE FUNDS ADJUTANT GENERAL'S BRANCH PART I PARTICULARS OF THE APPLICANT/SERVICEMEN/EX-SERVICEMEN 1. a) Name of the applicant : b) Permanent Address : c) Present Address : 2. Details of the Servicemen / Ex-Servicemen : (a) No. ........ Rank ......... Name ....... Unit /Corps ................... . (b) Relationship with applicant ................. . (c) Date of commission / Enrolment ............ (d) Date of retirement / discharge ............. (e) Date of casualty including death ............ (f) Cause of casualty including death ................ (g) Age at the time of casualty including death .......... . (h) Is death/Disability attributable of ................. aggravated to Service ............ .. Yes / No ... (i) Physical condition of the applicant ................ . 3. Details of applicant's Bankers: (a) Name of Bank and Branch : (b) Postal Address : (c) Account No. ........ SB/CD No.......... 4. Details of family dependants :- MONTHLY INCOME: 5. (a) Rate of Monthly pension & ............. .. Age .. Salary ( Including allowances) (b) Children Allowances : (i) For No. of Children .............. (ii) Rate per month.............. (iii) Total Amount ............... (c) Children education allowances: (i) For No. of Children ............... (ii) Rate per month.............. . Sl. No. Name Age & Sex Relationship Profession & Individual Income if applicable (iii) Free AOCEE ............... (iv) Aid from any other ............... Source / State PREVIOUS GRANTS : 6. Details of previous grants/assistance received from Central / State Govts./ Army Source (including DGR/Kendriya Sainik Board) Date Source/Fund Amount (a) ....... .............. ...... (b) ....... .............. ...... (c) ....... ............... ....... (d) ........ .............. ....... LUMPSUM RECEIPTS:-Details of all lumpsum receipts are as under :-Date Amount a. From Army Group Insurance Scheme b. DSOP c. From LIC d. Service Gratuity e. Family Gratuity f. Terminal Gratuity g. Death - cum - retirement gratuity h. Ex.gratia award (flying accidents) i. Rehabilitation grant ( for EC officer ) j. Commuted value of pension received k. Any other amount received with source OTHER ASSETS: 8. My other assets are as under:- Name of the Amount Income Bank/Company (Year) a. Current/ Saving account b. Fixed Deposits c. Recurring Deposits d. Shares/Bonds e. Saving Certificate f. Unit Trusts g. Any other deposits Total DETAILS AND INCOME FROM PROPERTY 9. Immovable property Urban/ Area Total Income Rural Value ( Year) a. Land i) Agricultural ii) Non - Agricultural b. House(s) i) ii) c. Commercial i) ii) d. Hired land/ building Total MOVABLE PROPERTY (ABOVE Rs.2,000/- each) Details of property Value Income a. b. c. d. b. Total INCOME FROM OTHER SOURCES 10. Details of monthly income form other sources are as follows: a. Source Income Monthly FAMILY BUDGET 11. Present monthly family budget as follows: (a) House owned / hired house at the rate of ....... per month (b) Total education expense at the rate of ....... per month (c) Food cost at the rate of ....... per month (d) Clothing & other necessities at the rate of ....... per month Total PART III : BRIEF CIRCUMSTANCES OF DISTRESS CERTIFICATE Certified that all the above facts have been correctly revealed and no information has been cancelled to the best of my knowledge. Dated: ...... . Signature of the applicant NOTE 1. Application for the first grant should be submitted in duplicate direct to the command in which serving or to the Zila Sainik Board/Rajya Sainik Board/ OCRecords/ Army HQ, whichever is applicable 2. Applications for the subsequent grants should be submitted, in duplicate, direct to the Command where now serving or to the respective Zila Sainik Board/Rajya Sainik Board/ OC Records which dealt with first application 3. Casualty includes death invalidment, retirement, release, discharge, resignation, dismissal or cashiering 4. Case of invalidment/death should indicate - Battle casualty . Casualty with authority if possible. PART - IV VERIFICATION AND RECOMMENDATIONS 1. The above statements have been verified as correct, except, as 2. Recommendations:- Secretary, Zila/Rajya Sainik Board or Sponsoring Officer of the Lt.Col & above rank Affix Office Seal PART - V : RECOMMENDATION OF THE COMMAND ( Where applicable) Dated: PART - VI : FOR USE AT ARMY HEADQUARTERS Dated: PART - VII GRANT(S) SANCTIONED Fund: Amount: Dated: Sanctioning Authority INDIAN NAVAL BENEVOLENT ASSOCIATION: 1. Educational Scholarships to children of pensioners beyond higher secondary stage. 2. Educational Scholarships to handicapped children between the ages of 3 to 18 years, i.e., for a period of 15 years. 3. Grant in aid to NOK on pensioners' death. 4. Assistance upto Rs.10,000/- for starting self help economic venture to ex-Sailors and sewing machines to widows. 5. Reimbursement of expenditure on treatment of serious diseases to pensioners. 6. Rehabilitation grant of Rs.7,500/- to all Sailors on invalidment from service due to TB/ Paraplegic/ Leprosy. 7. Marriage grant of Rs.10,000/- (for Officers) and Rs.5,000/- (Sailors) per child of personnel who die in harness or as pensioners.
