Beneficiary Name _*

Aadhaar Card Number _*

Name of the Village _*

Taluka _*

District _*

State _*

Pincode _*

Mobile Number _*

Date of Birth _*

Photo _*

Bank Name _*

Bank Account Number _*

IFSC Code _*

Bank Branch _*

The name of the person from whom the information was received

Terms / Conditions

I would like to take advantage of the above scheme and I am presenting the above information.I have read the terms / conditions of the presented scheme and accordingly I am giving the information online as above.If the information I have given is found to be false, the benefit of the scheme should be withdrawn immediately or the entire amount should be recovered from me and I will not mind.

Note: The office does not guarantee that the benefit of the scheme will be paid if you apply for the above scheme. (Beneficiaries who are determined on the basis of the provision received are given a grant-in-aid with limited sanction of Rs. 2000 / -

I agree with all the above text