APPLICATION FOR CLAIM OF FINANCIAL ASSISTANCES FROM NAVY WIVES WELFARE ASSOCIATION APPLICATION FOR FINANCIAL AID PART - I 1. (a) Name of deceased officer/sailor ( in Block Capitals) ------------------------------------Photograph (b) Rank of officer/sailor at of time of his death --------------------------------------- Applicant (c) Number of deceased officer/sailor -------------------- (d) Name of applicant ( Widow) ---------------------------- 2. Unit last served by the deceased officer/sailor ----------------- 3. Date of his death ---------------------------------- 4. Circumstances of his death (briefly) -------------------------- 5. Whether in receipt of ordinary Family Pension/ Special Family Pension --------------------------- 6. (a) PPO No. -------------------- (b) Treasury to which Pension remitted ------------------ 7. In case widow has married state the place and date of re-marriage ----------------------------------------------------- 8. Present Postal Address --------------------------------------------------------------with PINCODE -------------------------------------------------------------- 9. Bank/Post Office Account,if any, (with complete address and pincode) (Payments would be made only cross cheque/Bank drafts, Post Office/Bank Account would be necessary) ----------------------------------------- PART - II 10. Details of financial Assistance received by the widow in the past: (a) Naval Headquarters (b) Other State/Central Government Sources 11. Were your children provided any out of turn employment by Government/Navy? 12. Do you have any serving sons in the Navy, Army, Airforce? if so, gives details of name, rank, number and address in the present unit. PART - III 13. Certified that the information given above are complete and correct to the best on my knowledge. Signature ----------------Verification of signature/thumb impression by Panchayat President / Ward Councillor /Class I Gazetted Officer Signed in my presence Signature ------------------------Date -------------------Name/Designation ---------------------------- PART IV 14. The facts given above by the applicant are correct to the best of my knowledge. Signature of serving Naval officer or Date ------------------Secy, ZILA SAINIK BOARD
