PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: EDUCATION GRANT (Only for School/College going children (max two) of ESM upto Havildar)

PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am _________________________________________a pensioner/non-pensioner ESM/widow. I request for education grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy)

Rank

Enrolment

Discharge

Death (Strike out if not Applicable)

6.

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge:

Exemplary/Very Good/Good/Fair/Bad

(Strike out whichever is not applicable)

8.

Dependents of ESM: a) Wife: _________________________________ b) Mother: ____________________ ___________ c) Father: ________________________________

Son/Daughter d)____________________________ e)____________________________ f)____________________________ g)____________________________

Children for whom the grant is applied 9. Name

Name of School/College

* Class passed

Marks obtained (in %)

(* One year grant to be claimed for every successful academic year)

10.

Additional Information if any ________________________________________________________________________________ ________________________________________________________________________________ Financial Condition Report 11.

(a)

Pension (Basic pm for pensioners)

Rs.

(b)

Monthly income for non-pensioners:

Rs.

(from other sources)

12.

If re-employed, income there from:

Rs.

13.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Declaration 14. I understand that this is a grant meant for education assistance of Rs 1,000/- pm for boy & girl child respectively (Maximum two children) and not a tuition fee reimbursement scheme. I have no legal right on the amount requested for. 15. I hereby declare that the information furnished in personal application cum financial condition report is correct to the best of my knowledge

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATION BY ZSW OFFICER 16. Following original documents of ESM/Widow./Orphan have been personally checked by ZSW Officer (Photocopies attested by ZSWO are attached): a)

Complete Discharge Certificate/book.

b)

Certificate from school/college giving date of birth and marksheet of successful candidates.

17. It is certified that the applicant has not been provided any financial assistance from the State Govt or any other source. 18. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: PENURY GRANT (Only for Non-Pensioners above 65 Yrs of Age) PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am ______________________________________ a non-pensioner ESM/Widow. I request for penury grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy)

Rank

Enrolment

Discharge

Date of Birth

Death (Strike out if not Applicable)

6.

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge:

Exemplary/Very Good/Good/Fair/Bad

(Strike out whichever is not applicable)

8.

Dependents of ESM a) Wife: _______________________________ b) Mother: __________________________ ___ c) Father: ______________________________

Son/Daughter d)_______________________________ e)_______________________________ f)_______________________________ g)_______________________________

9.

Additional Information if any _________________________________________________________________________________ _________________________________________________________________________________

10.

(a)

If re-employed, income there from:

Rs.

(b)

Monthly income for non-pensioners:

Rs.

(from other sources)

11.

12.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Details of Bank Account with address: A/C No. _________________________________________________________________________________ (ESM/widow to open A/c in SBI/PNB only)

Declaration 13. 14. 15. 16.

I understand that this is a grant only and I have no legal right on the amount requested for. I am a non-pensioner and not drawing any kind of pension from any agency. I hereby declare that the information furnished in personal application is correct to the best of my knowledge. I will apply for renewal of Penury Grant every year between 01 to 31 of Dec to my concerned ZSB.

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSW OFFICER 17. 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.

c)

A Certificate of Penury from village Sarpanch/Patwari/Block Development Officer for ESM/Widow appling for Penury Grant that the income of ESM/widow is not more than Rs 6000/-pm.

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

Date :

Signature :

Office Seal :

Designation : RECOMMENDATIONS BY SECRETARY, RSB

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

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: DISABLED CHILDREN GRANT

(Only For Disabled Children of ESM with 100% Disability) PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am ___________________________________________ a pensioner/non-pensioner ESM/widow. I request for disabled children grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy) Enrolment

6.

Rank

Discharge

Death

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge: (Strike out whichever is not applicable)

Exemplary/Very Good/Good/Fair/Bad

Details of the Children 8.

Name

9.

Date of Birth

Sex:

Male

Female

(dd/mm/yy)

10.

Additional Information if any

_________________________________________________________________________________ _________________________________________________________________________________ Financial Condition Report 11.

12.

(a)

Pension (Basic pm for pensioners)

Rs.

(b)

Monthly income for non-pensioners: ( from other sources).

Rs.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Declaration 13. 14.

I understand that this is a grant only and I have no legal right on the amount requested for. I am a non-pensioner and not drawing any kind of pension from any agency.

15.

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

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSB 16. Following original documents of ESM/Widow have been personally checked by ZSW Officer (Photocopies attested by ZSWO are attached): -

17.

a)

Dependent Identity Card issued by ZSB.

b)

Complete Discharge Certificate/book.

c)

100% disability certificate issued by military/civil Govt hospital.

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

source. 18. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: MARRIAGE GRANT (Only for Two Daughters/Widow of ESM upto Havildar) PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am _________________________________________ a pensioner/non-pensioner daughter/widow of ESM. I request for marriage/re-marriage grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy) Enrolment

Rank

Discharge

Death (Strike out if not Applicable)

6.

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge: (Strike out whichever is not applicable)

8.

Dependents of ESM a) Wife: _______________________________ b) Mother: __________________________ ___ c) Father: ______________________________

Exemplary/Very Good/Good/Fair/Bad

Son/Daughter d)_______________________________ e)_______________________________ f)_______________________________ g)_______________________________

9.

Actual date of Solemnization (dd/mm/yy)

10.

Additional Information if any _________________________________________________________________________________ _________________________________________________________________________________

Financial Condition Report 11.

(a)

Pension (Basic pm for pensioners)

Rs

(b)

Monthly income for non-pensioners :

Rs.

Rs.

(from others sources)

12.

If re-employed, income there from:

Rs.

13.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Declaration 14. I understand that this is a grant only and I have no legal right on the amount requested for. I am entitled to marriage grant once only for two daughters/widow out of RMDF. 15. I hereby declare that the information furnished in personal application cum financial condition report is correct to the best of my knowledge

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSWO 16. Following original documents of ESM/Widow./Orphan (Photocopies attested by ZSWO are attached): -

have been personally checked by ZSW Officer

a)

Complete Discharge Certificate/book.

b)

Age (not below 18 Yrs) proof of the daughter.

c)

Marriage certificate issued by Registrar of Birth/Death/Marriages.

17. It is certified any other source.

that the applicant has not been/ been provided any financial assistance from the State Govt or

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

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: MEDICAL GRANT (Only for Non ECHS members/Non Pensioners upto Havildar) (Only for Pensioners/Non-pensioners ESM of NDGs) PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am _____________________________________________________ a non-ECHS pensioner/non-pensioner ESM/Widow/Orphan of ESM. I request for medical grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy) Enrolment

Rank

Discharge

Death (Strike out if not Applicable)

6.

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge: (Strike out whichever is not applicable)

8.

Dependents of ESM a) Wife: _______________________________ b) Mother: __________________________ ___ c) Father: ______________________________

9.

Exemplary/Very Good/Good/Fair/Bad

Son/Daughter d)_______________________________ e)_______________________________ f)_______________________________ g)_______________________________

Additional Information if any _________________________________________________________________________________ _________________________________________________________________________________

Financial Condition Report 10.

(a)

Pension (Basic pm for pensioners)

Rs.

(b)

Monthly income for non-pensioners:

Rs.

(from other sources)

11.

If re-employed, income there from:

Rs.

12.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Declaration 13. I understand that this is a grant meant for medical assistance upto Rs 30,000/- only and not a reimbursement scheme. I have no legal right on the amount requested for. 14. I hereby declare that the information furnished in personal application cum financial condition report is correct to the best of my knowledge.

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSW OFFICER 15. Following original documents of ESM/Widow./Orphan (Photocopies attested by ZSWO are attached): -

have been personally checked by ZSW Officer

a)

Complete Discharge Certificate/book.

b)

Original medical bills/receipts countersigned by the attending doctor.

c)

Discharge certificate/summary from the hospital and countersigned by the attending doctor.

16. It is certified that the applicant has not been provided any financial assistance from the State Govt or any other source. It is also certified that the applicant is not an ECHS member. 17. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: OFFICER’S TRAINING GRANT

(Only for Wards of ESM upto Havildar) PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am _____________________________________ a pensioner/non-pensioner ESM/widow. I request for officer’s training grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy) Enrolment

Rank

Discharge

Death (Strike out if not Applicable)

6.

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge: (Strike out whichever is not applicable)

Exemplary/Very Good/Good/Fair/Bad

Gentleman Cadet/Cadet 8.

Name

9.

Cadet No.

10.

Date of Joining Officer Training Institute (NDA) (dd/mm/yy)

11.

Additional Information if any ________________________________________________________________________________ ________________________________________________________________________________

Financial Condition Report 12.

(a)

Pension (Basic pm for pensioners)

Rs.

(b)

Monthly income for non-pensioners:

Rs.

(from other sources)

13.

If re-employed, income there from:

Rs.

14.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Declaration 15.

I understand that this is a grant only and I have no legal right on the amount requested for.

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

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSW OFFICER 17. Following original documents of ESM/Widow./Orphan (Photocopies attested by ZSWO are attached): -

have been personally checked by ZSW Officer

a)

Complete Discharge Certificate/book.

b)

Certificate from training institute certifying the details as given by the applicant in para 8-10 are correct

and the gentleman cadet has been promoted to next term.

18. It is certified that the applicant has not been provided any financial assistance from the State Govt or any other source. 19. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: HOUSE REPAIR GRANT (Only for ESM/Widows/100% Disabled ESM/Orphan Daughter upto Havildar rank)

PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am ___________________________________ a non-pensioner ESM/Widow/Orphan of ESM. I request for house repair grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy) Enrolment

Rank

Discharge

Death (Strike out if not Applicable)

6.

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge:

Exemplary/Very Good/Good/Fair/Bad

(Strike out whichever is not applicable)

8.

Dependents of ESM: a) Wife: _________________________________ b) Mother: ____________________ ___________ c) Father: ________________________________

Son/Daughter d)______________________________ e)______________________________ f)______________________________ g)______________________________

9.

Cause of damage _________________________________________________________________

10.

Additional Information if any

_______________________________________________________________________________ _______________________________________________________________________________ Financial Condition Report 11.

(a)

Pension (Basic pm for pensioners)

Rs.

(b)

Monthly income for non-pensioners:

Rs.

(from other sources)

12.

If re-employed, income there from:

Rs.

13.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

Declaration 14.

I understand that this is a grant only and I have no legal rights on the amounts requested for.

).

15. I am neither in receipt and nor denied of old age/WW-II pension/financial assistance under any State Govt/Central Govt scheme. 16. I hereby declare that the information furnished in personal application cum financial condition report is correct to the best of my knowledge

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSW OFFICER 17. Following original documents of ESM/Widow./Orphan (Photocopies attested by ZSWO are attached): -

have been personally checked by ZSW Officer

a)

Complete Discharge Certificate/book.

b)

Owner Certificate.

c)

Certificate from State Govt regarding cause of damage and estimate cost.

d)

Notification issued by Central/State Govt declaring that the damage is due to natural calamity.

e)

100% Disability Certificate (for 100% Disabled ESM).

f)

Death certificate of parents (for orphan daughter).

18. It is certified that the applicant has not been provided any financial assistance from the State Govt or any other source. 19. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

RECOMMENDATIONS BY SECRETARY, RSB 20. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: FUNERAL GRANT (Only for Widows of ESM upto Havildar)

PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am ________________________________________a pensioner/non-pensioner widow/orphan. I request for funeral grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy) Enrolment

6.

Rank

Discharge

Death

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge:

Exemplary/Very Good/Good/Fair/Bad

(Strike out whichever is not applicable)

8.

Dependents of ESM: a) Wife: _________________________________ b) Mother: ____________________ ___________ c) Father: ________________________________

9.

Son/Daughter d)______________________________ e)______________________________ f)______________________________ g)______________________________

Additional Information if any

_______________________________________________________________________________ _______________________________________________________________________________ Financial Condition Report 10.

(a)

Pension (Basic pm for pensioners)

Rs.

(b)

Monthly income for non-pensioners:

Rs.

(from other sources)

11.

If re-employed, income there from:

Rs.

12.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Declaration 13. I understand that this is a grant only and I have no legal right on the amount requested for. 14. I hereby declare that the information furnished in personal application cum financial condition report is correct to the best of my knowledge.

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSW OFFICER

15. Following original documents of ESM/Widow./Orphan have been personally checked by ZSW Officer (Photocopies attested by ZSWO are attached): a)

Complete Discharge Certificate/book.

b)

Death Certificate.

16. It is certified that the applicant has not been provided any financial assistance for the same cause from any other source. 17. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: ORPHAN GRANT (For Orphan children of ESM (PBOR & Officers) (Rs 1,000/- per month upto Daughters of ESM Till She is married and One Son of ESM upto 21 years of age )

PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am ____________________________________ a pensioner/non-pensioner unmarried orphan of an ESM. I request for orphan grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy) Enrolment

6.

Rank

Discharge

Death

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge:

Exemplary/Very Good/Good/Fair/Bad

(Strike out whichever is not applicable)

Details of Orphan Daughter: 8.

Name

9.

Date of Birth

Marital Status : Married

Unmarried

(dd/mm/yy)

10.

Additional Information if any

_______________________________________________________________________________ _______________________________________________________________________________ Financial Condition Report 11.

(a)

Pension (Basic pm for pensioners)

Rs.

(b)

Monthly income for non-pensioners:

Rs.

(from other sources)

12.

If re-employed, income there from:

Rs.

13. Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Declaration 14. I understand that this is a grant only and I have no legal right on the amounts requested for. 15. I hereby declare that the information furnished in personal application cum financial condition report is correct to the best of my knowledge

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSW OFFICER 16. Following original documents of ESM/Widow./Orphan have been personally checked by ZSW Officer (Photocopies attested by ZSWO are attached): a)

Dependent Certificate.

b)

Complete Discharge Certificate/book.

c)

Date of Birth Certificate.

d)

Certificate from competent authority certifying that the applicant is not married.

17. It is certified that the applicant has not been provided any financial assistance from the State Govt or any other source. 18. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

PERSONAL APPLICATION CUM FINANCIAL CONDITION REPORT: VOCATIONAL TRAINING GRANT

(Only for Widow of ESM upto Havildar) PERSONAL APPLICATION The Secretary Kendriya Sainik Board 1. I am _____________________________________ a pensioner/non-pensioner widow. I request for vocational training grant out of RMDF.

Particulars of ESM 2.

Name

3.

Service No.

4.

Present Address:

5.

Dates (dd/mm/yy)

Rank

Enrolment

Discharge

Death (Strike out if not Applicable)

6.

Reasons for discharge: (As in Discharge Certificate)

7.

Character at the time of discharge: (Strike out whichever is not applicable)

Exemplary/Very Good/Good/Fair/Bad

8. Name

Remarks

Name of Institute

(* One year grant to be claimed for every successful academic year)

9.

Additional Information if any ________________________________________________________________________________ ________________________________________________________________________________

Financial Condition Report 10.

(a)

Pension (Basic pm for pensioners)

Rs.

(b)

Monthly income for non-pensioners:

Rs.

(from other sources)

11.

If re-employed, income there from:

Rs.

12.

Details of Financial Assistance received in past from KSB/RSB/ZSB (Name of grant _______________________________ Amount_________________, year

).

Declaration 13.

I understand that this is a grant only and I have no legal right on the amount requested for.

14. I hereby declare that the information furnished in personal application cum financial condition report is correct to the best of my knowledge.

Name & Relationship

(Signature/Thumb impression of the applicant)

RECOMMENDATIONS BY ZSW OFFICER 15. 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)

Certificate from training institute.

c)

Certificate from ZSB that the widow after having undergone vocational training is gainfully employed.

16. It is certified that the applicant has not been provided any financial assistance from the State Govt or any other source. 17. I hereby declare that the information furnished above is correct as per the original documents of the applicant. Hence, case is recommended.

Date :

Signature :

Office Seal :

Designation :

--------------------------------------------------------------------------------------------------------------------Date :

To, The Secretary Kendriya Sainik Board New Delhi

Sub : FINANCIAL ASSISTANCE FOR PENURY GRANT

Respected Sir I am ---------------------------------------------------------------------------------------------------------I am above 65 years old and not getting any type of pension/family pension from Central / State Govt. I have no any source of income to pull on day-to-day life.

2.

I am always sick due to old age. I am not receiving any financial assistance from any other

source.

3.

May, I request you to, please grant me a monthly penury grant for my daily maintains.

Thanking you,

Yours faithfully,

-----------------------------------------

To whom it may concern

This is certified that Army No. --------------------------Name-----------------------------------------Age, ---------- years residence of our grampachyat / ward ie Vill & Post-----------------------------The--------------------------Dist----------------------. I personally know to the above Ex Serviceman and His financial condition is very poor and his monthly income is below Rs 6000/- pm.

Round Seal

Signature of Village Sarpanch/ Corporator

Date: