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નોંધણી/ઓળખપત્ર અરજી - સ્વ. સૈનિકના ધર્મપત્નિ માટે
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REGISTRATION & ISSUE OF IDENTITY CARD

FORM FOR WIDOWS/WAR WIDOWS OF EX-SERVICEMEN

1. Name _______________________________
2. Date of Birth_____________________
3. Address                                              # Tele No: _______________________ _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
# Original Native State ________________ # Proficiency in Gujarati __________ (Yes or No)
4. Particular of Husband:
# Date of Birth (Husband) ___________ # Date of Death (Husband) ___________

No. ___________________ Date of enrollment _______________________

Rank __________________ Date of discharge _______________________

Name ___________________ Discharge book No. & date __________________

Decoration ______________ Regt/Corps ____________ PPO NO. & date __________

Religion _______________________ Caste ________________________

5 Details of Husband's death :

War/Operation _____________________ Attributable _________________________

Non Attributable _____________________ After retirement ______________________

6. Details of family (only dependent children upto 25 yrs and dependent parents of deceased ex-Servicemen)

Name

DOB

Relationship

Educational Qualification

i)      
ii)      
iii)      
iv)      
v)      
vi)      
vii)      

7. Amount of family pension
Ordinary Rs. ____________________ Special Rs. ________________________
Liberalised special family pension Rs. ________________________________

8. Lump sum payment received:
(by her & husband)

 

Gratuity Rs. ________________________ Group Insurance Rs. ________________

Encashment of leave Rs. __________________________________

Financial Assistance Rs. __________________________________

Commuted Pension Rs. ___________________________________

9. Present Occupation and monthly income:
Service Rs. ______________________Business/Industry Rs. ____________________
Agriculture Rs. _____________________ Un-employed ________________________

10. Other relevant Information, if any ______________________________________

11. Identification Mark: __________________________

12. Left thumb impression ________________________

DECLARATION

     I hereby declare that the particulars given above are true to the best of my knowledge and belief.

Date:

Place:                                      (Signature of the Applicant Widow of Ex-serviceman)

 

VERIFICATION

The above Widow falls in the category of ex-Serviceman’s widow. The Identity Card No GUJ/0__ / ______ Dated__________ is prepared for issue to the individual after due verification & signature or the DSWRO.

The category of the widow is (Tick Appropriate category):-

    • War –Op Widow
    • Attributable Military Service (Died while in Service)
    • Non Attributable Military Service (Died while in Service)
    • Widow of ESM died after Retirement

Date:

Place:                                   (Signature of staff verifying Details & preparing ID card)

COUNTER SIGNED

Date:

Place:                                                                                                               (Signature of DSWRO)

 


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Last updated on 19-01-2007