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  • SCH2 - Application For Medical Relief Fund For Minority Muslim Women and Female Children

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    Shaik Azmath
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    This document contains an application format for requesting medical relief funds from the Karnataka State Wakf Foundation for Women Development. The application requests information such as the patient's name, address, annual income, details of the illness, estimated medical costs, hospital information, and any previous medical relief received. It must be signed by the patient or relative and supporting documents must be enclosed for verification.

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    SCH2- Application for Medical Relief Fund for Minority Muslim Women and Female Children

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    This document contains an application format for requesting medical relief funds from the Karnataka State Wakf Foundation for Women Development. The application requests information such as the patient's name, address, annual income, details of the illness, estimated medical costs, hospital information, and any previous medical relief received. It must be signed by the patient or relative and supporting documents must be enclosed for verification.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    31 views1 page

    SCH2 - Application For Medical Relief Fund For Minority Muslim Women and Female Children

    Uploaded by

    Shaik Azmath
    This document contains an application format for requesting medical relief funds from the Karnataka State Wakf Foundation for Women Development. The application requests information such as the patient's name, address, annual income, details of the illness, estimated medical costs, hospital information, and any previous medical relief received. It must be signed by the patient or relative and supporting documents must be enclosed for verification.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    APPLICATION FORMAT FOR SANCTION OF MEDICAL RELIEF FUND TO MINORITY MUSLIM WOMEN & FEMALE CHILDREN To The Hon

    ble Minister for Wakf, Haj, Minorities Welfare & Chairman, Karnataka State Wakf Foundation for Women Development,

    Patient s Passport size photo

    No. 84-A, Sadath Hajj House, 1st Floor, Richmond Road, Bangalore 560025
    1. 2. 3. 4. Residential Address with Phone No. 5. Annual Income (Income limit less than Rs1.20 lakhs) Nature of Disease (Medical Certificate from Hospital/Nursing Home) Name & Address of the Hospital/Nursing Home (Enclosed estimated cost) Hospital s Bank A/C No. Name & Branch. If already treated Hospital/Nursing home Bills to be enclosed, Patient s bank Name/Address and Account No. Is there any medical relief taken earlier from Govt/Organization/Institution etc. Mention details. Document enclosed. 1. 2. 3. 4.

    Name of the Patient Name of the Father/Husband/Guardian Age & Occupation

    6.

    7.

    8.

    9.

    10.

    I request you to sanction Medical Relief from KSWF for Women Development s Medical Relief Fund. What is stated above is true and correct to the best of my knowledge and belief. Place: Date:

    Signature of Patient/Parent/Relatives.

    NOTE: Enclose Original Income Certificate, Hospital Estimate, Amount paid receipt & Residential Address Proof (Xerox Copy)

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