Annexure 'I' (Performa) APPLICATION FORM FOR PAYMENT OF FINANCIAL ASSISTANCE TO EX-SERVICEMEN/WIDOWS ABOVE THE AGE 65 YEARS 1. Name of Ex-serviceman 2. Name of Wife/Widows 3. Father's Name (Only in case of ESM) 4. Date of Birth 5. Date of enrollment in Army 6. Date of Retirement 7. Reasons for retirement 8. Permanent address 9. Name of Banker and Saving Account No. 10. Monthly income from all sources: (a) Land (b) Shop/Business (c) Financial assistance (d) Pension 11. Is he/she living with dependent Signature of Applicant Recommendations of Screening Committee of District Sainik Welfare Office Recommended/Not Recommended District Sainik Welfare Officer Sanctioned/Not Sanctioned Director Sainik Welfare Punjab
