GOVERNMENT OF SIKKIM

SOCIAL WELFARE DEPARTMENT

GANGTOK

                     FORM I

(See clause 8/1)

SIKKIM WIDOWS REMARRIAGE SCHEME, 1993.

Application Form for payment of incentives to be submitted by eligible person.

1.                    Name :___________________________________Signature :______________

(In block Letters)

2.                    (i) Date of birth :_______________________________________________________

(by Christian era)______________________________________________________

(ii) Permanent Address:_________________________________________________

(iii) Present Address :___________________________________________________

3.                    Occupation :

4.                    Marital status :                                             BACHELOR/WIDOWER/DIVORCE

5.                    If widow or divorce, please indicate the following :

(i)                   Name of deceased/divorce wife:_________________________________

(ii)                 Date of death/divorce of the

Deceased/divorce wife:________________________________________

(iii)                Details of children from the previous marriage (s).

6.             (i) Has the marriage been already solemnized:                                                YES/NO.

                (i) If yes, provide the following details of the widow:

                                (a) Name of the widow :________________________________________

                                (b) Her date of birth/Age :______________________________________

                                © Name of the deceased husband of the widow:

                                (d) Date of death of the deceased husband:

7.             If the marriage has already been solenised, please

                indicate the following:

(i)                   Name of the person/priest/Marriage Officer

Who solemnised the marriage:

(ii)                 Date on which the marriage was solemnised :

(iii)                Name of the two witnesses before whom the

Marriage was solemnised. 

                                                                                1.____________________________

2.____________________________

8.             (i) Whether the eligible person has fostered or

                  proposes to foster any child/children born to