Modified Appx ‘A’ to AI/01/05 dated 10 Jan 05

To,

Marshal of the Air Force & Mrs. Arjan Singh Trust

C/O Air Force Association

Race Course Camp,

Air Force New Delhi

New Delhi – 110003

APPLICATION FOR FINANCIAL GRANT

1.Name of the applicant …………………………………………………Widow/Son/daughter of …………………………………………….

2.Service No. ……………………………………… 3. Rank ……………………….. 3(a) Trade……………………………………………………..

4.Address ……………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………

5.Tele/Mobile No. ………………………………………… E-mail id ………………………………………………………………………………….

6.AFA Life Membership No. ……………………………. (Mandatory for AF veterans, their widows/dependents)

7.Is the applicant member of ECHS or Central/State medical scheme: - Yes/No (If not reason there off) …………….. ………………………………………………………………………………………………………………………………………………………………………………………

8.Date of Birth: - …………………………………………….. Date of Enrolment/Commissioning…………………………………………..

9.Date of Discharge ………………………………………… Date of death (If applicable)..…………………………………………………….

10.Reason of Discharge …………………………………………………………. Cause of Death ……………………………………………………

11.Details of occupation/civil employment after discharge from the service …………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………………

12.Pension(Service/ Civil/ Family/ Disability)……………………………… + DA………………………………………………………………

(With a copy of latest PPO and bank statement for last two years)

13.Any other Income …………………………………………………………………………………………………………………………………………….

14.Present Status (Employed/Unemployed.If employed photocopy of pay slip is mandatory)………………………………

15.Details of ancestral/own house ………………………………………………………………………………………………………………………..

16.Details of ancestral/own property ……………………………………………………………………………………………………………………

17.Income from ancestral property/self owned property/ own house ………………………………………………………………….

(If not proof from appropriate authority is mandatory)

18.Particulars of family members (Dependent Mother and father, Wife , Sons and daughters) with a copy of proof

Sl No. / Name of the Individual / Relation with Air Force personnel / Dependant or not / Age and sex / Educational qualification / Occupation / Monthly income

19.Bank name, address, IFSC code and saving account no. ..………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………………………………

20.Purpose for seeking grant in brief …………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

21.Details of previous grant/assistance received from Central/State Govt./Air Force source/Kendriya Sainik Board/ECHS etc

Date / Source / Amount

22.Brief circumstances of distress(with proof & duly authenticated by the competent authority) ……………………………………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………………

CERTIFICATE

23.Certified that all the above facts have been correctly revealed and no information has been concealed to the best of my knowledge.

Date ………………………………..Signature of the applicant

Caution : Any wrong declaration or concealment of the facts may adversely affect consideration of the application and may debar you from further assistance/financial help. In your own interest please fill details correctly. No column should be left blank.

24.Recommendation by the respective branch of the Air Force Association/AOC/Stn Cdr/OC Unit.

Date:-

Official Seal: -AOC/Stn Cdr/OC Unit(or)

AFA Branch head

25.Following documents are to be sent as applicable:-

(a)Photocopy of ESM/Widow I card and AFA Card.

(b)Attested copy of Discharge book/ Discharge Certificate.

(c)Original Medical bills and treatment certificate from the doctor (In case of medical grant)

(d)Marriage invitation card andtwo different joint photographs of the newly married couple at the time of marriage (In case of daughter’s marriage only)

(e)Relevant documents relating/supporting any other distress situation/contingency.

(f)Latest salary slip of sons and daughters duly certified by their employer.

(g)Latest pay slip for serving personnel (Mandatory).

Note: - Forward the application through respective branch of Air Force Association or nearest AF unit or Zila Sainik Board