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Chief Editor & PublishersBrig.Suresh Kumar Verma

(Retd.)Director

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2-;q~} esa 'kghn gq;s lSfudksa o viax gq;s lSfudksa dks fgekpy izns'k ljdkj}kjk vuqxzg iwoZd jkf'k (Ex-gratia Grant) iznku dh tkrh gS Afgekpy izns'k ljdkj }kjk 25 ebZ 2015 ls vuqxzg iwoZd nh tkus okyh jkf'k dhnj fuEufyf[kr izdkj ls c<kbZ xbZ gS %&

1. Rs.5.00 Lac to the next of kin of Battle Causality. 2. Disabled soldiers during operation @ Rs.1.50 Lac

(50% disability or above) and Rs.75,000/- below 50% disability).

3. Members of Para Military Forces, who die in active operations @ Rs.1.50 lac.

4. Physical Causality @Rs. 35,000/-.

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[4]

LIST OF SAINIK REST HOUSES IN HIMACHAL PRADESH

Sr. Name of Sainik Rest House Name of Distt. Telephone NosNo1. Chamba Chamba 01899-222357

2. Chowari Chamba ….do…

3. Nurpur Kangra 01892-223279

4. Dehra Kangra ….do…

5. Kangra Kangra …do…

6. Jawalamukhi Kangra …do…

7. Palampur Kangra ….do…

8. Dharamshala Kangra ….do…

9. Keylong L&Spiti 01902-222272

10. Kullu Kullu …do…

11. Mandi Mandi 01905-222120

12. Sarkaghat Mandi …do..

13. Hamirpur Hamirpur 01972-222334

14. SujanpurTihra Hamirpur …do…

15. Una Una 01975-226090

16. Ghumarwin Bilaspur 01978-222343

17. Bilaspur Bilaspur …do…

18. Solan Solan 01792-223764

19. Parwanu Solan …do…

20. Nahan Sirmour 01702-222551

21. Paonta Sahib Sirmour …do…

22. Longwood Shimla Shimla 0177-2658586

23. Matiana Shimla …do…

24. RekongPeo Kinnour ….do…

[5]

8. PMSS SCHEME :- 44 children of ESM/their widow have been selected under this scheme. The details are as under :-

LIST OF SELECTED PMSS SCHEMESl. S.S. CANDIDATE NAME GEN CATE MEQ % PURSUING RSB NAME ESM PARTICULARS A/C NUMBERNo. No. DER GORY COURSE

1 33012 RADHU KATOCH M 1 75.40% B.TECH H.P EX NK TARSEM CHAND 202559787842671493 ARMY

2 33014 RACHNA DEVI F 1 73.60% B.SC(NURS) H.P EX NK SURJEET SINGH 33474621311RANA 2682875K ARMY

3 33028 RANJANA KUMARI F 2 65.60% B.SC(NURS) H.P EX GNR RAMESH KUMAR 222200010912647414389086 ARMY

4 33599 ISHANT JASWAL M 6 95.00% B.TECH H.P EX HAV HOSHIAR SINGH 2025555689714402211 ARMY

5 33600 VIPASHA SHARMA F 6 95.00% MBBS H.P EX PORC ANIL KUMAR 34401854581167381N NAVY

6 34404 SAVI BHARDWAJ F 6 91.20% B.TECH H.P EX SGT ASHOK KUMAR 1183001500010530SHARMA 686664K IAF

7 34405 DIWANSHI RANA F 6 91.20% B.SC(AGRI) H.P EX PO SATISH KUMAR 3311001500534152RANA 168314H NAVY

8 34437 ASHISH DEHAL M 6 91.00% B.TECH H.P EX NB SUB NIRMAL KUMAR 2248001500001016369453P ARMY

9 34438 VISHAL KUMAR M 6 91.00% MBBS H.P EX HAV KISHORI LAL 11170015046637801079442N ARMY

10 34464 ADITYA DEV SHARMA M 6 90.83% BE H.P EX POR SUKH DEV 097250Z 2721000109378833NAVY

11 34481 ANKITA F 6 90.80% B.SC(BIO-TECH) H.P EX CFN RAKESH KUMAR 2528001500173750DOAD 14596459A ARMY

12 34482 ANKITA SHARMA F 6 90.80% BVSC & AH H.P EX SGT JIWAN JYOTI 31440334577SHARMA 628572G IAF

13 34574 PAYAL THAKUR F 6 90.40% B.SC(NURS) H.P EX HAV SUBHASH CHAND 2023413659414568981M ARMY

14 34783 NEHA SOOD F 6 89.60% MBBS H.P EX NK AJAY KUMAR SOOD 3421008767314242821W ARMY

15 34840 BANIT KUMAR M 6 89.40% B.TECH H.P EX NK BADRI RAM 15410015020478202682917L ARMY

16 34853 AAKRITI F 6 89.33% BE H.P EX JWO PRATAP SINGH 34287851940654296G IAF

17 35125 NAVDEEP SINGH M 6 88.00% B.TECH H.P EX HAV GORKH NATH 20192917551CHOUDHARY 1077551 ARMY

18 35216 AKSHAY THAKUR M 6 87.60% B.TECH H.P EX HAV VINOD KUMAR 021100010930396713754610M ARMY

19 35270 AKASHDEEP SINGH M 6 87.40% B.TECH H.P EX HAV GORKH NATH 20139031806CHOUDHARY 1077551 ARMY

20 35557 ANUPAM KAUSHAL M 6 86.00% B.TECH H.P EX SGT PARTAP SINGH 6439000100031717KAUSHAL 686427R IAF

21 35558 PANKAJ KUMAR SHARMA M 6 86.00% BE H.P EX NAIB SUB BK SHARMA 2024513927415360957N ARMY

22 35628 ABHISHEK SINGH THAKUR M 6 85.60% BVSC & AH H.P EX SUB RAJINDER SINGH 2448000100831371159651A ARMY

23 35629 RISHABH KATOCH M 6 85.60% BE H.P EX SUB MAJ BHANUPRATAP SHISHU 367965H

24 35692 AMIT SHARMA M 6 85.20% B.TECH H.P EX NK PARVEEN KUMAR 3239892790914908626Y ARMY

25 35727 SHIVAM RANAUT M 6 85.00% BE H.P EX SUB AJIT SINGH 20173552681518920H ARMY

26 35812 VIKRANT SHARMA M 6 84.60% B.TECH H.P EX NAIB SUB RAVI 32387289403BHUSHAN 349494X ARMY

27 35813 SHIVALI SHARMA F 6 84.60% B.SC(NURS) H.P EX NK KHEM RAJ 2025056904914497838N ARMY

28 35850 SMRITI F 6 84.40% B.DESIGN H.P EX NAIB SUB TILAK RAJ 172700010407976715357986X ARMY

29 35956 PRASHANT SHARMA M 6 84.00% B.TECH H.P EX JWO SURESH KUMAR 11159575670SHARMA 640751S IAF

30 35957 RIYA THAKUR F 6 84.00% BE H.P EX MCERA PARVEEN 20231807568KUMAR SAKLANI 193268-Y

31 36090 MADHU MALHOTRA F 6 83.33% B.TECH H.P EX HAV BHARAT RAJ 343669891866927358K ARMY

32 36162 AKSHAY MALTA M 6 83.00% BE H.P EX SUB RAM PARKASH 34328267665MALTA 756736L ARMY

33 36277 VISHAL RANA M 6 82.40% B.TECH H.P EX DFR BALRAM SINGH 64110015000107931084500W ARMY

34 36310 PRATIGYA F 6 82.20% B.SC(NURS) H.P EX HAV KAMLESH KUMAR 3404266405213973984F ARMY

35 36342 AMAN GAUTAM M 6 82.00% B.TECH H.P EX NAIB SUB SIKHVINDER 20148032694SINGH 581300F ARMY

36 36343 MANOJ KUMAR M 6 82.00% B.TECH H.P EX HAV HEM RAJ 172000010083434914359854M ARMY

37 36399 PRASHANT M 6 81.80% B.TECH H.P EX PO PRITAM CHAND 0375001500014404168123Z ARMY

38 36533 SONAM RANA F 6 81.16% B.ED H.P EX SUB DEEP CHAND RANA 34306541453579500Y ARMY

39 36567 ADHITYA SHARMA M 6 81.00% B.TECH H.P EX SEP ASHWANI KUMAR 3373001500031732GAUTAM 1069523A ARMY

40 36596 DINESH KUMAR M 6 80.80% B.TECH H.P EX HAV GULWANT KUMAR 339922632062678549K ARMY

41 36640 PUNEET SHARMA M 6 80.60% B.TECH H.P EX DFR RAJ KUMAR 25280001002292471098785Y ARMY

42 36716 VISHAL KUMAR SONI M 6 80.20% B.SC(HHA) H.P EX SUB RAJENDER KUMAR 20242916121SONI 642971 ARMY

43 36717 AYUSHI ACHARYA F 6 80.20% B.TECH H.P EX HAV ANUJ KUMAR 29340001030866689510052A ARMY

44 36814 SHIVANI F 6 79.80% B.TECH H.P EX SUB JOGINDER SINGH 1732001500000621420665L ARMY

[6]

dsUnz ljdkj}kjk

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[7]

FINANCIAL ASSISTANCE FOR EX-SERVICEMENIN PENURY

1. Background :- The scheme to provide financial assistance to non-pensioner Ex-servicemen (ESM) in a state of penury was started in year 1981 with an amount of Rs.100 per month for a period of two years.Thereafter, it was increased to Rs.500/- per month for two years in 2007 and then changed into onetime grant of Rs.30,000/- for life time. This was revised by this Management Committee of AFFD Fund in Oct 2011 and revised the one time grant into a monthly grant of Rs.1000/-.

2. Aim:- The aim of this aid gratis is to provide a small measure of relief from total penury to a non-pensioners ESM up to rank ofHav/equivalent and their widow.

3. Financial Assistance :- For Penury is provided at the rate of Rs.1000/- per month per head for life time from AFFD Fund.

4. Eligibility Conditions:- The eligibility criteria are to be met to avail financial assistance under this scheme are as follows :-

(a) Must be non-pensioner ESM or his widow.

(b) Should be of rank Havildar/equivalent from the Navy/AF and below

(c ) Should be above age of 65 years

(d) Should be recommended by respective ZSB and RSB

(e) Details of bank account (in SBI/PNB only) and IFS Code

5. Application Form:- Application should be made in given form with recommendation of respective ZSWO & Secretary, RSB on it. Copies of the following documents duly attested by ZSWO must accompany the application :-

[8]

(a) Service Document/Discharge Book of ESM

(b) Age Proof, if date of birth not given in the Service Document/ Discharge Book

(c ) Identity Card of ESM/Widows issued by ZSB

(d) Details of Bank A/c No (in PNB/SBI only) and IFS Code.

(e) Aadhar Card copy.

(Specimen of Application Form attached on Annexure-I)

FINANCIAL ASSISTANCE FOR EDUCATION OF CHILDREN/WIDOWS OF ESM1. Background:- This scheme to provide financial assistance to ESM and their widows for helping them in educating their wards was started in 1981 with an amount of Rs.15/- per child per month for a maximum of three children up to Class XII. This scheme was last revised in Oct 2011 into a monthly grant of Rs.1000/- per month per child (for maximum two children) up to graduation and also for widows to pursue Post Graduation degree.

2. Aim :- Aim of this scheme is to provide scholarship to up to amaximum of two dependent children of ESM or their widows, up tothe ranks of Havildar in the Army and equivalent in the Navy and AirForces, and to widow for Post Graduation degree courses.

3. Financial Assistance :- For education is provided out ofAFFDFund @Rs.1000/- per month per head (up to max twochildren) of eligible ESM and their widows, for the previousacademic year, payable in one installment in a financial year. This isapplicable for classes 1 to 12 of school and undergraduate classesof a degree college. This grant is also admissible to widows whowish to pursue 2 year post graduate degree. This grant is notapplicable for any of the professional or technical courses/degrees.

[9]

4. Eligibility Conditions :- The following criteria must be fulfilled to avail this grant :-

(a) Applicant must be an ESM/Widow/Orphan dependent.

(b) Should be of rank Havildar/equivalent and below

(c ) The child should have passed the previous class

(d) Should be recommended by respective ZilaSainik Board (ZSB)

(e) Should not be drawing education allowance from the State or his Employer

5. Application :- Application should be made on the prescribed application form with recommendation of concerned Zila Sainik Welfare Officer (ZSWO) on it. Copies of the following documentsduly attested by the respective ZSWO must be accompany theapplication :-

(a) Complete Discharge Book/Documents

(b) ESM or Widow I-Card issued by respective ZSB

(c ) Mark-sheet /School Progress Card of Child/Children

(d) Part-II Order mentioning names of the child(ren) for which grant is sought or there should be a proper entry to this effect in the Discharge Book/ documents.

(e) A certificate from applicant saying that he/she has not taken any money/grant from the state or present employer in the form of education allowance or scholarship.

(f) Details of Bank A/c No (in PNB/SBI only) and IFS Code.

( g) Aadhar Card copy

(Specimen of Application Form attached on Annexure-II)

[10]

FINANCIAL ASSISTANCE TO 100% DISABLED CHILD OF ESM

1. Background . The Ex-Servicemen (ESM), like all men in society, are also prone to misfortunes. In an unfortunate event of his child born deformed or later disabled due to accident/natural causes/disease, his capacity to deal with the misery is comparatively lower than the others in the society. In such a scenario, it is the responsiblility of the organisation to assist ESM in looking after his disabled child and provide them some help to resettle in life. The scheme to provide financial assistance to those ESM who are without any other source of income and in a state of penury, was started in 2007 with an amount of Rs. 500/- per month. This rate was last revised on file in Oct. 2011 with an amount of Rs. 1,000/-per month.

2. Aim . The aim of this aid gratis is to provide a small measure of relife to 100% disabled children of ESM.

3. Financial Assistance. For the disabled child out of AFFD Fund will be provided at a rate of Rs. 1000/- per month payable on monthly basis during the financial year.

4. Eligibility Conditions. The following criteria must be fulfilled :- (a) Child must be a legitimate offspring of ESM/Widow. (b) ESM should be of the rank of Havildar/equiv of the Navy/Air Force

and below. © The child should be 100% disabled. (d) Should not be in receipt of any disability benefit from any

official agency. (e) Should be recommended by respective Zila Sainik Board (ZSB).

5. Application. Application should be made on the prescribed application form with recommendation of Zila Sainik Welfare Officer (ZSWO) on it. A specimen application form is placed at Annexure 1 to this document. Copies of the following documents duly attested by ZSWO must accompany the application :-

(a) Photocopy of Discharge Book (must have entry regarding child). (b) ESM and Dependent Identity Card issued by ZSB. © 100% disability certificate issued by Military/Govt. Hospital. (d) Details of Bank A/c No. (in PNB/SBI only) and IFS Code.

(Specimen of Application Form attached on Annexure-III)

[11]

FINANCIAL ASSISTANCE FOR DAUGHTER'S MARRIAGE/WIDOWSREMARRIAGE

1. Background :- This scheme provides financial assistance to Pensioner/Non-Pensioner Ex-servicemen (ESM) up to the rank of Havildar or equivalent in the Navy/Air Force. The scheme was started in way back in the year 1981 with an amount of Rs.3000/-per daughter. This was revised in May 2007 to Rs.16,000/- per head and applicable up to two daughters. 2. Aim :- The aim of this aid gratis is to provide financial assistance to ESM or widows up to the rank of Havildar for marriage of their daughters. 3. Financial Assistance :- Paid out of AFFD Fund is provided for marriage of daughters of an eligible ESM or widow and remarriage of widows, at a rate of Rs.16,000/- per daughter (maximum two). 4. EligibilityConditions: - The following criteria must be fulfilled :-

(a) Applicant must be an ESM or his widow. (b) Should be of rank Havildar& below (c ) The daughter should be above 18 years of age(d) Should be recommended by respective ZSB (e) Should not have obtained any financial grant for

this purpose from State/Other Services 5. Application :- Application should be made on the prescribed application form with the recommendation of respective ZilaSainik Welfare Officer (ZSWO) on it. Copies of the following documents duly attested by respective ZSWO must accompany the application :-

(a) Discharge Book/Document (must have entry regarding daughter)

(b) Proof of Age of the daughter. (c ) Proof of Marriage- Certificate from

Registrar/Village Sarpanch(d) A Certificate from Applicant that he/she has

not taken any money/assistance /grant from respective State Govt/ Services towards the daughter's marriage

(e) Details of bank A/c No (in PNB/SBI only) and IFS Code.

(Specimen of Application Form attached on Annexure-IV)[12]

Annexure I

APPLICATION FOR FINANCIAL ASSISTANCE FROM KSB ; PENURY (Only for Non-Pensioners above 65 Yrs of Age)

1. Name : ____________________ Service No. ___________ Aadhar No. : _________

2. Rank _____________________ 3. Present Address : ________________________

__________________________________________________________________

4. Dates : (dd/mm/yy) Enrolment : ____/____/____ Discharge : ______/______/_____

Birth : ____/____/____ Death : ____/____/____ 5. Resons for Discharge : (As in Discharge Certificate) : _________________________

6. Character at the time of discharge : Exemplary/ Very Good/ Good/ Fair/ Bad. 7. Mobile No. : _____________________ Residence Landline No. ________________

8. (a) If re-employed, income there from employment : Rs. _____________________

(b) Monthly income for non-pensioners (from other sources) Rs. ________________

9. Details of Financial Assistacne received in past from KSB/RSB/ZSB (mention each

type of grant) : Name of Grant ______________ Amount ________ Year __________

10. Name & Address of Bank : _____________________________________________

11. IFSC/NEFT Code of Bank : ____________________________________________

12. Account No. ________________________________________________________

13. Additional Information if any ____________________________________________

DECLARATION

14. I understand that this is only an assistance I have no legal right on the amount requested for.

15. I am a non-pensioner and not drawing any kind of pension or grant from any agency.

16. I hereby declare that information furnished in personal application is correct to the best of my knowledge.

17. If my application is sanctioned. I will apply for renewal of Penury Grant every

year between 01 to 31 of Dec to my concerned ZSB.

(Signature of the applicant)

[13]

RECOMMENDATIONS BY ZSW OFFICER

18. Following original documents of ESM/Widow have been personally checked by ZSW Officer (Photocopies attested by ZSWO are attached) :- (a) Complete Discharge Certificate/Book. (b) Age proof of applicant. © A Certificate of Penury from Village Sarpanch/Patwari/Block Development

Officer for ESM/Widow applying for Penury and that the ESM/Widow is not receiving pension or grant from Govt. or any other agency.

(d) Attested copy of ESM/Widow Identity Card. 19. It is certified that the applicant does not have income/pension from any other

source and he has not been provided any financial assistance from the State Govt. or any other source.

20. I hereby confirm that the information furnished above is correct as per the original

documents of the applicant. Hence, case is recommended.

Date : Signature :Rank & Name :

Official Seal : Designation : Dy Dir/Asst Dir/ZSWO

RECOMMENDATIONS BY SECRETARY, RSB21. I hereby declare that the information furnished above is correct as per the originaldocuments of the applicant, Hence, case is recommended.

Date : Signature :Rank & Name :

Office Seal Designation : Director/Secretary

[14]

LIFE CERTIFICATE FOR ESM IN PENURY(To be submitted in January each year through ZSB)

It is hereby certified that Non Pensioner Ex-Servicemen/Widow’s No. : _________

Rank : ___________________________ Name : ________________________

Service : Army/Navy/Air Force Date of Birth : ___________

Signatures of Individual Thumb Impression of Individualis alive and present before me today.

Place : ______________________ Signature : ___________________

Date : _______________________ Rank & Name : _____________________

Designation : Asst Dir/ Dy Dir/ Secy ZSB

Office Seals Office : ______________ Distt. _________

(Certificate can be issued by AD/DD/JD/ Secretary of respective ZSB)

[15]

Annexure II

APPLICATION FOR FINANCIAL ASSISTANCE FROM KSB : EDUCATION (For School/College going Children of ESM upto Havildar)

ACADEMIC YEAR

1. Name : ______________________ Service No. _________ Aadhar No. __________

2. Rank ___________ 3. Present Address : __________________________________

__________________________________________________________________

4. Dates : (dd/mm/yy) Enrolment : ____/____/____ Discharge : ______/______/_____

Birth : ____/____/____ Death : ____/____/____

5. Reasons for discharge : (As in Discharge Certificate) : ________________________

6. Character at the time of discharge : Exemplary / Very Good/ Good/ Fair/ Bad.

7. Name of Dependents Children :

(a) ______________________ (b) ________________ © ____________________

8. Children for whom the Grant is applied (* One year grant to be claimed for every

successful academic year)

Name Name of School/College Class Pass *Marks obtained %

9. Mobile No. : _____________________ Residence Landline No. ________________

10. (a) Pension (Basic pm for pensioners) Rs. _____________________

(b) If re-employed, income there from employment : Rs. _____________________

© Monthly income for non-pensioners (from other sources) Rs. _________________

11. Details of Financial Assistance received in past from KSB/RSB/ZSB (mention

each type of grant ) :

Name of grant _______________________ Amount _____________ Year : _______

12. Name & Address of Bank : _____________________________________________

13. IFSC/NEFT Code of Bank : ___________________ 14. Account No. _____________

15. Additional Information if any ____________________________________________

[16]

DECLARATION16. In understand that this is only an assistance meant for education assistance @ Rs.

1,000/- pm per child. (Max two children) and not a tuition fee reimbursement scheme. I I have no legal right on the amount requested for.

17. I solemnly declare that I am not drawing children’s education allowance from Govt., current employer or any other agency.

18. I hereby declare that the information furnished in personal application cum

financial condition report is correct to the best of my knowlegde.

Name & Relationship (Signature/Thumb impresssion of the applicant)

RECOMMENDATION BY ZSW OFFICER19. Following original documents of ESM/Widow/Orphan have been personallychecked by ZSW Officer (Photocopies attested by ZSWO are attached) :-

(a) Complete Discharge Certificate/book showing details of ESM, widow & children (b) Certificate from school/college giving date of birth and marksheet of

successful candidates. © ESM or widow or dependent (in case of orphan) Identity Card.

20. It is certified that the applicant has not been provided any financial assistance for children’s education from the State Govt. or any other source.

21. I hereby confirm that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date : SignatureOffice Seal : Rank & Name :

Designation : Dy Dir/Asst Dir/ZSWO

[17]

Annexure III

APPLICATION FOR FINANCIAL ASSISTANCE FROM KSB ; DISABLED CHILD (For Disabled Children of Havildar & Below ESM having 100% Disability)

1. Name : ____________________ Service No. ___________ Aadhar No. : _________ 2. Rank _____________________ 3. Present Address : ________________________

__________________________________________________________________ 4. Dates : (dd/mm/yy) Enrolment : ____/____/____ Discharge : ______/______/_____

Birth : ____/____/____ Death : ____/____/____ 5. Resons for Discharge : (As in Discharge Certificate) : _________________________ 6. Character at the time of discharge : Exemplary/ Very Good/ Good/ Fair/ Bad. 7. Name of Disabled Child ________________ Nature of Disability ________________

%age ______________________________ 8. Mobile No. : _____________________ Residence Landline No. ________________ 9. (a) Pension (Basic pm for pensioners) Rs. ____________________

(b) If re-employed, income there from employment : Rs. ____________________© Monthly income for non-pensioners (from other source) Rs. __________________

10. Details of Financial Assistance received in past from KSB/RSB/ZSB (mention each type of grant) : ________________________ Amount ____________ Year _______

11. Name & Address of Bank : _____________________________________________ 12. IFSC/NEFT Code of Bank : ____________________________________________ 13. Account No. ________________________________________________________ 14. Additional Information if any ____________________________________________

DECLARATION15. I understand that this is financial assistance only and I have no legal right on the

amount requested for. 16. I solemnly declare that I am not drawing disability grant or assistance from Govt.

or any other source for the above mentioned child. 17. I herby declare that the information furnished in personal application is correct

to the best of my knowledge. (Signature of the applicant)

RECOMMDATIONS BY ZSB18. Following original documents of ESM/Widow have been personally checked

by ZSW Officer (Photocopies attested by ZSWO are attached) :- (a) Dependent Identity Card issued by ZSB. (b) Complete Discharge Certificate/book showing details of ESM/Widow and child. © 100% disability certificate issued by military/civil Govt. Hospital. (d) ESM/widows I card.

19. It is certified that the applicant has not been provided any financial assistance from the State Govt. or any other source in respect of above mentioned disabled child.

20. I hereby confirm that the information furnished above is correct as per the Original documents of the applicant. Hence, case is recommended.

Date : SignatureOffice Seal : Rank & Name :

Designation : Dy Dir/Asst Dir/ZSWO

[18]

Annexure IVAPPLICATION FOR FINANCIAL ASSISTANCE FROM KSB ; MARRIAGE

(upto Two Daughters of ESM or widows upto Havildar)

1. Name : ____________________ Service No. ___________ Aadhar No. : _________ 2. Rank _____________________ 3. Present Address : ________________________

__________________________________________________________________ 4. Dates : (dd/mm/yy) Enrolment : ____/____/____ Discharge : ______/______/_____

Birth : ____/____/____ Death : ____/____/____ 5. Resons for Discharge : (As in Discharge Certificate) : _________________________ 6. Character at the time of discharge : Exemplary/ Very Good/ Good/ Fair/ Bad. 7. Name of Disabled Child ________________ Nature of Disability ________________

%age ______________________________ 8. Mobile No. : _____________________ Residence Landline No. ________________ 9. (a) Pension (Basic pm for pensioners) Rs. ____________________

(b) If re-employed, income there from employment : Rs. ____________________© Monthly income for non-pensioners (from other source) Rs. __________________

10. Details of Financial Assistance received in past from KSB/RSB/ZSB (mention each type of grant) : ________________________ Amount ____________ Year _______

11. Name of Dependent Daughters : (a) ______________________________________ (b) ______________________________________

12. Actual Date of Solemnization (dd/mm/yy) _________________________________ 13. Name & Address of Bank : _____________________________________________ 14. IFSC/NEFT Code of Bank : ____________________________________________ 15. Account No. ________________________________________________________ 16. Additional Information if any ____________________________________________

DECLARATION17. I understand that this is a financial assistance only and I have no legal right on the

amount requested for. I am entitled to marriage grant once only for marriage of two daughters.

18. I solemnly declare that I have not obtained any financial assistance/grant for this marriage from Govt. or any other agency.

19. I herby declare that the information furnished in personal application is correct to the best of my knowledge.

(Signature of the applicant)RECOMMENDATIONS BY ZSB

20. Following original documents of ESM/Widow have been personally checked by ZSW Officer (Photocopies attested by ZSWO are attached) :- (a) Complete Discharge Certificate/book showing details of ESM/Widow and child. (b) Age (not below 18 yrs.) proof of the daughter. (c) Marriage Certificate issued by Registrar of Marriages.

21. It is certified that the applicant has not been provided any financial assistance from the State Govt. or any other source.

22. I hereby confirm that the information furnished above is correct as per the Original documents of the applicant. Hence, case is recommended.

Date : SignatureOffice Seal : Rank & Name :

Designation : Dy Dir/Asst Dir/ZSWO

[19]

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