GOVERNMENT OF SIKKIM
SOCIAL WELFARE/WELFARE DEPARTMENT
GANGTOK
APPLICATION FORM FOR GRANT OF SUBSISTENCE ALLOWANCE FOR DISABLED PERSONS
1. Name of applicant
2. Fathers Name/Husbands Name/Wifes Name
3. Age as on 1.4.1998 ..
4. Panchayat Unit & Ward Post Office .
Sub Division . District Constituency .
5. Family Card No
6. Sikkim Subject Certificate Identification Certificate Land Parcha Yes/No
7. Whether the applicant is recipient of any other assistance from Yes/No.
Government of other sources.
To the best of my belief and knowledge, the information given above are true, if any of the information given is found to be incorrect subsequently. I agree to discontinuation of the assistance under this scheme.
SIGNATURE OR THUMP IMPRESSION OF THE APPLICANT
To be enclosed:-
1. 3 recent passport photos.
2. Copy of Sikkim Subject/Land Parcha etc.
3. Photocopy of 1st/2nd and 4th page of Vikash Patrika.
4. Monthly income.
DOCTORS CERTIFICATE
This is to certify that Shri/Smt/Kumari S/O, D/O, W/O
.Age .Years, resident of
..has ..% ..
(Visual/Locomotive/Speech/Hearing/Mental handicapped and is not fit to fend for himself/herself).
His/Her case is recommended for grant of Subsistence Allowance.
Signature and Seal of concerned Specialist or C.M.O.