Meeseva FORM OF APPLICATION CLAIMING FAMILY BENEFIT-NFBS District Admin

Meeseva FORM OF APPLICATION CLAIMING FAMILY BENEFIT-NFBS District Admin 

Download here Meeseva FORM OF APPLICATION CLAIMING FAMILY BENEFIT-NFBS 
The FORM OF APPLICATION CLAIMING FAMILY BENEFIT (FB)Application Form will be like below download the form and fill all the details and attach required documents:

FORM OF APPLICATION CLAIMING FAMILY BENEFIT-NFBS 
FORM OF APPLICATION CLAIMING FAMILY BENEFIT (FB)
UNDER NSAP
PART-1
(To be filled in by the Head of the Surviving family)
District_______________ Mandal____________
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.5,000/- per month or more.
(b) I am the surviving head of the family of the deceased Primary bread winner.
(c) The Primary bread winner died at the age of ____________ (Proof like Death Certificate to
be attached)
(d) The deceased was resident of District Where he had been residing for last 3 years
immediately preceding
the death.
(e) 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