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7D.D.40 Form
APPLICATION FOR GRANTS FROM ARMY CENTRAL WELFARE FUND
ADJUTANT GENERAL BRANCH
PART- I : PARTICULARS OF
APPLICANT
1.
Particulars of Applicant/Serviceman/Ex-serviceman
(a)
Name of the Applicant: ___________________________________
Age __________ Years.
(b)
Permanent Address: ____________________________________
____________________________________
____________________________________
____________________________________
(c)
Present Address :
___________________________________
____________________________________
____________________________________
____________________________________
(d)
Physical condition of the Applicant: _________________________
_______________________________________________________
(e)
Occupation: _____________________________________________
2.
Details of the Serviceman/Ex-serviceman :-
(a)
No______________Rank ___________Name __________________
_________________Unit/Corps______________________________
(b)
Relationship with the Applicant: _____________________________
(c)
Date of Commission/Enrolment: _____________________________
(d)
Date of Retirement/Discharge
: _____________________________
Total Service ______________________________________________
(e)
Date of casualty including death: _____________________________
(f)
Age at the time of casualty
: _____________________________
Including death
(g)
Cause of casualty including death: ____________________________
_________________________________________________________
(h)
Is Death/Disability attributable or aggravated to
Service: _________________________________________________
(j)
Character (As assessed on Discharge Certificate)
____________________________Yes/No _____________
…2/-
D.D.40 Form
APPLICATION FOR GRANTS FROM ARMY CENTRAL WELFARE FUND
ADJUTANT GENERAL BRANCH
PART- I : PARTICULARS OF
APPLICANT
1.
Particulars of Applicant/Serviceman/Ex-serviceman
(a)
Name of the Applicant: ___________________________________
Age __________ Years.
(b)
Permanent Address: ____________________________________
____________________________________
____________________________________
____________________________________
(c)
Present Address :
___________________________________
____________________________________
____________________________________
____________________________________
(d)
Physical condition of the Applicant: _________________________
_______________________________________________________
(e)
Occupation: _____________________________________________
2.
Details of the Serviceman/Ex-serviceman :-
(a)
No______________Rank ___________Name __________________
_________________Unit/Corps______________________________
(b)
Relationship with the Applicant: _____________________________
(c)
Date of Commission/Enrolment: _____________________________
(d)
Date of Retirement/Discharge
: _____________________________
Total Service ______________________________________________
(e)
Date of casualty including death: _____________________________
(f)
Age at the time of casualty
: _____________________________
Including death
(g)
Cause of casualty including death: ____________________________
_________________________________________________________
(h)
Is Death/Disability attributable or aggravated to
Service: _________________________________________________
(j)
Character (As assessed on Discharge Certificate)
____________________________Yes/No _____________
…2/-
-2-
3.
Details of Applicant’s Bankers :-
(a)
Name of the Bank and Branch: ________________________________
________________________________
(b)
Postal Address of the Bank
:________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
(c)
Account No : _______________________________________________
4.
Details of Family/Dependents:-
Ser
Name
Age
Relation Whether
Profession
School &
No
dependent
&
class
of
individual
studying if
independent
income if
applicable
applicable
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
5. ____________________________________________________________________
PART –II: PRESENT FINANCIAL STATE OF APPLICANT
5.
Monthly Income:-
(a)
Rate of monthly pension/
: __________________________________
Payment/or All Allowances
(Including) (Give PPO No.
And date).
(b)
Children Allowance:-
(i)
No. of children
: _________________________________
(ii)
Rate per month
: _________________________________
(iii)
Total Amount
: _________________________________
….3/-
-3-
(b)
Children Educational Allowances:-
(i)
No. of children
: ________________________
(ii)
Rate per month
: ________________________
(iii)
From AOCEF (Only in
:_________________________
the case of Army
Officers)
(iv)
Aid from any other
: ________________________
Scholarship/State
_________________________________________________
_________________________________________________
Previous Grants:-
6.
Details of previous grants/assistance received from Centre/State Govt/Army
Source (including DGR, KSB & Rajya Sainik Boards)
Ser
Date
Source/Fund
Amount
No
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
5. ____________________________________________________________________
Lump-Sum Receipt
7.
Details of all lump sum receipt are as under :-
Date
Amount
(a)
From Army Group Insurance Scheme
(b)
DSGP
(c)
From LIC
(d)
Service Gratuity
(e)
Family Gratuity
(f)
Terminal Gratuity
(g)
Death-cum-Retirement Gratuity
(h)
Ex-Gratia Award (Flying Accident)
(j)
Rehabilitation Grant (for Ex-Officer)
(k)
Commuted value of pension received.
(l)
Any other amount received with
Sources.
…4/-
-4-
Other Assets
8.
My other assets are as under:-
Name of the Bank/
Amount
Income
Company
(Yearly)
(a)
Current/Saving
_______________
_______
______
Account
(b)
Fixed Deposits
_______________
_______
______
(c)
Recurring Deposits
_______________
_______
______
(d)
Shares/Bonds
_______________
_______
______
(e)
Saving Certificates
_______________
_______
______
(f)
Unit Trust
_______________
_______
______
(g)
Any other deposits
_______________
_______
______
(h)
Income from other sources:-
Sources
Income
(Monthly)
(i)
(ii)
(iii)
Total
______________________
Details and Income from Property
9.
Immovable property:-
Urban/
Area
Total
Income
Rural
Value
(Yearly)
(a)
Land:-
(i)
Agricultural
______
_______ _______
_____
(ii)
Non -Agricultural
______
_______ _______
_____
(b)
House:-
(i)
(ii)
(c)
Commercial:-
(i)
(ii)
(d)
Land/Building: ____________________________________________
…5/-
-5-
10.
Movable Property (Above Rs. 2,000.00 each)
Details of property
Value
Income, if
Any
(a)_________________________________
_________
__________
(b)_________________________________
_________
__________
(c)_________________________________
_________
__________
(d)_________________________________
_________
__________
(e)_________________________________
_________
__________
(f)_________________________________
_________
__________
Total Rs.
_________
__________
Family Budget
11.
Present monthly family budget are as follows:-
(a)
House-own/hired expenses
______________ per month.
the rate of
(b)
Total education expenses
______________
(c)
Food Cost
______________
(d)
Clothing and other necessities
______________
Total Rs.
______________
12.
No. & date of Identity Card issued by ZSB if any
____________________________________________________.
PART-III BRIEF CIRCUMSTANCES OF DISTRESS
CERTIFICATE
Certified that all the above facts have been correctly reported and no information
has been left to the best of my knowledge.
Date:
2006
(Signature of Applicant)
Caution:
Any wrong declaration or concealing effects may adversely effect
consideration of the applicant and may debar you from any further
assistance/financial help.
