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10. If re-employed, income there from: Rs. ______________________________________________________________
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11. Details of Financial Assistance received in past from KSB/RSB/ZSB
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(Name of grant _________________________________Amount _____________________Year _________________) |
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2
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12. Assistance to old and infirm Ex-serviceman/widow (Monthly Grant of Rs.2000/- pm for two years)
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(a) Whether the ESM/dependent is in receipt of old age/WW-II pension/ financial assistance given by the state Govt. under various State Govt. schemes.
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(b) If not eligible for old age/ WW-II pension/ financial assistance under any State Govt. schemes, the reasons thereof: _______________________________________________________________
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(c) Whether the Certificate from Secy. ZSB is enclosed stating that the ESM/ Widow is above the 65 years of age and is not in receipt of any type of Financial Assistance/Pension from any other agency: _______________________________________
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Eligibility Conditions:
For Non-Pensioners only and not in receipt of any kind of Financial Assistance from any agency. |
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13. Assistance to old and infirm Ex-serviceman/Widow(Penury Grant of Rs.30,000/-) |
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(a) Whether the ESM/Widow is in receipt of old age/WW-II Pension/ financial assistance given by the State Govt. under various State Govt. schemes
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(b) If not eligible for old age/ WW-II pension/ financial assistance under any State Govt. schemes, the reasons thereof: ______________________________________________________________________________
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Eligibility Conditions: For Non-Pensioners only. |
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14. Assistance to old and infirm Ex-serviceman/Widow(Penury Grant of Rs.500/-pm) |
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(a) Whether the ESM/Widow is in receipt of old age/WW-II Pension/ financial assistance given by the State Govt. under various State Govt. schemes
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(b) If not eligible for old age/ WW-II pension/ financial assistance under any State Govt. schemes, the reasons thereof: _____________________________________________________________________________________
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(c) Whether the Certificate from Old Age Home/Gram Pradhan certifying that the ESM/Widow is staying at Old Age Home/Own house has been attached .________________________________________________________________
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Eligibility Conditions:
For Non-Pensioners only of above 70 years of age (for old age home)and above 75 years of age (staying at own house). |
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15. Assistance to Orphan Children of Ex-serviceman with 100% disability(Penury Grant of Rs.500/-pm)
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(a) Whether the certificate by Military/Civil Hospital confirming 100% disability of Child/ Children is attached _____________________________________________________________ |
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(b) Whether the Death Certificate of Parents are attached ___________________________________________________
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(c) Whether the Dependency Certificate by ZSB is attached _________________________________________________
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Eligibility Conditions:
For Orphan Children with 100% disability only. |
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3
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16. Financial Assistance for Daughters Marriage /Widow Remarriage(Rs.16,000/-)
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(a) Actual date of solemnization: ______________________________________________________________________ |
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(b) Whether confirmation certificate/Marriage Invitation Card is attached: ________________________________________ |
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(c) Age proof certificate of the daughter ________________________________________________________________
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Eligibility Conditions:
upto two daughters only. Maximum Gross Pension should be upto Rs.3000/- for ESM and Rs.Rs.3500/-for Widows. |
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17. Medical Grant( Upto a maximum of Rs.30,000/-only).
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(a) Whether the applicant approached MH/Govt. Hospital for treatment, if so, reference may be enclosed. If not, the reasons thereof _____________________________________________________________________________
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(b) Whether original medical bills/receipts have been countersigned by the competent medical authority and summary of medical bills/Hospital admission/discharge certificate enclosed ________________________________________________. |
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(c)
An undertaking will have to be given by the applicant availing the medical assistance/grant from RMDF/AFFDF as follows :- |
"I (Name) ________________________ Rank ___________________ No _______________ have clearly understood the provisions/guidelines of RMDF/AFFDF that these are not reimbursement scheme and are merely ex-gratia grants for medical assistance/grants to the maximum amount of Rs. 30,000/- and Rs. 1.00 lakh respectively and I will not resort to any litigation in any court to claim in the reimbursement of the treatment."
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Eligibility Conditions
: Maximum Gross pension should not be more than Rs. 3000/- for ESM and Rs. 3500/- for widows and should not be member of ECHS. |
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18. Grant for Children Education for wards of ESM/Widows upto XII Std(Rs. 200/- pm for boys & Rs. 400/- pm for girls, per child for maximum of Two children). |
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(a) Particulars of child/children from whom the education grant is applied for :- |
Sl No
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Name
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Name of School
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Class in which studying
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Years of session
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(b) Whether certificate obtained from the concerned school confirming date of birth/ Mark sheet and above details have been enclosed :-_________________________________________________________________________
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(c) Whether the Dependency certificate by ZSB is attached. _________________________________________________ |
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Eligibility Conditions
: Maximum Gross Pension should be upto Rs. 3000/- for ESM and Rs. 3500/- for widows. |
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4
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19. Grant for Children Education for Graduation for girls only(Rs.600/-per month) |
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(a) Particulars of girls child/children from whom the education grant is applied for:-
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Sl No
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Name
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Name of College/Institute
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Year of Graduation
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Session
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(b) Whether certificate obtained from the concerned College/Institute confirming date of birth/ Mark sheet and above details have been enclosed :-______________________________________________________________________________
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(c) Whether the Dependency certificate by ZSB is attached. _________________________________________________
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Eligibility Conditions
: Maximum Gross Pension should be upto Rs. 3000/- for ESM and Rs. 3500/- for widows. |
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20. Grant for Children joining Defence Officers Training Institute like NDA/IMA for the duration of the Training(Rs.1000/-per month)
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(a) Particulars of child from whom the grant is applied for:-
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Sl No
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Name
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Name of Defence Institute
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Year of Training
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Duration of Training
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(b) Whether certificate obtained from the concerned Defence Institute confirming that the candidate is admitted as a Cadet has been enclosed :-__________________________________________________________________________________ |
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(c) Whether the Dependency certificate by ZSB is attached. _________________________________________________
|
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Eligibility Conditions
: Maximum Gross Pension should be upto Rs. 3000/- for ESM and Rs. 3500/- for widows. |
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21. Grant of House Repair for ESM/Widows in Penury or 100% Disabled ESM (upto a maximum of Rs.20,000/-).
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(a) Cause of damage: ______________________________________________________________________________
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(b) Whether certificate obtained from Gram Pradhan is enclosed: ______________________________________________
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(c) Whether any relief has been given by the State Govt./other authority ? if not, reasons thereof:- _______________________________________________________________________________________________
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Eligibility Conditions
: Only if the damage is due to natural calamities like flood, Earthquake, Fire and any other. The Maximum Gross Pension should be upto Rs. 3000/- for ESM and Rs. 3500/- for widows. |
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22. Grant of House Repair for Orphan Daughter(upto a maximum of Rs.20,000/- for one daughter only).
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(a) Cause of damage: ______________________________________________________________________________ |
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(b) Whether certificate obtained from Gram Pradhan is enclosed: ______________________________________________
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(c) Whether any relief has been given by the State Govt./other authority ? if not, reasons thereof:- _____________________________________________________________________________________________
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(d) Whether the Death Certificate of Parents are attached ___________________________________________________
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(e) Whether the Dependency Certificate by ZSB is attached. _________________________________________________
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Eligibility Conditions
: For one Orphan Daughter only (PBORs & Officers). |
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23. Funeral Allowance to the Widows of ESM (Rs.5,000/-one time).
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(a) Date of death: _________________________________________________________________________________
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(b) Whether Death Certificate is enclosed: _______________________________________________________________
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(c) Whether any relief has been given by the State Govt./other authority ? if not, reasons thereof:- _______________________________________________________________________________________________
|
|
5
|
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Eligibility Conditions
: Maximum Gross Pension should be upto Rs. 3000/- and should be apply within three months of Death of ESM. |
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24. Financial Assistance to the Orphan Daughters of ESM(PBOR & Officers) (Rs.1000/-per month upto marriage or 21 Years whichever is earlier).
|
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(a) Whether Death Certificate is enclosed: _______________________________________________________________
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(b) Whether the Dependency Certificate is enclosed: _______________________________________________________
|
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(c) Whether any relief has been given by the State Govt./other authority ? if not, reasons thereof:- _____________________________________________________________________________________________
|
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Eligibility Conditions
: For one Orphan Daughters only. |
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25.
Declaration by the applicant, "I understand that this is an ex-gratia grant only and I have no legal rights on the amounts requested for. Further I understand that only one of the above grants is applicable to me and I will not ask for any further grants out of RMDF". |
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(Signature/Thumb impression of the applicant) |
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26. Specific recommendation of Secretary, Zila Sainik Board: ________________________________________________
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_______________________________________________________________________________________________ |
_______________________________________________________________________________________________ |
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Date : |
Signature: |
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Office Seal: |
Designation: |
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Note:- The case of financial assistance from RMDF is processed on the basis of information/particulars furnished in the FCR by the ZSB. The Zila Sainik Welfare Officers should ensure that information/particulars given in the form are correct. Copy of the Discharge Certificate and ESM Identity card should be attested by Zila Sainik Welfare Officer.
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/copy/
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Tele: 26188098 |
Government of India Ministry of Defence Kendriya Sainik Board West Block-IV, Wing-V RK Puram, New Delhi-66
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189/KSB/B/RMDF/Gen/07 |
Dt. 04 Jul 07 |
|
Director/Secy Rajya Sainik Board Gujarat
|
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FORWARDING OF NEW REVISED FINANCIAL CONDITION REPORT
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1. The New revised Financial Condition Report (FCR) is enclosed herewith for your perusal and information please. |
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2. It is requested to vet the cases at your end so as to ensure no repeated claims of same nature by a particular ESM are forwarded to this office. |
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Sd/- x x x
(HS Virdi) Jt Dir (Trg & Sch) For Secretary
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Encl: As above |