***

APPENDIX
APPLICATION CUM RECORD CARD FOREX-SERVICEMEN Passport Sle
DEPENDENT IDENTITY CARD Ploto of
tdependent tduly
attested by Hob
PARTI wlth blue back
PARTICULARS OF EX-SERVICEMEN ground without
s1pectacles and
(TODE FILLED IN CAPITAL LETTER ONLY Iead gear
.
Rank. 2. Name 3. No. '***'''
4. Date of Blrth... 5. Date Jolned Servlce.
6. Date of Retirement 7. PPO Number . . . * * " * * r * * *
8. ESM ID No. 9. Offlce Tel No..
10. Moblle No.. *******ttt* ** ******

11 Permanent' Home Address .

******'*****'*******'******"**'*** *******' *** ****'**'**'********
'*****'**°*' * ***t°**t0*ttte t*rt*eltt ***'*t* t**°********''''''''"''*"*'**'""*" ***'''t''*"""*''*'*"'""*****'"*"*

PART-1
PARTICULARS OF DEPENDENT
1 Name 3. DOB..
4.
Relatlonship.. 5. Aadhar Number...lttetun *'*''''
6.
Identification Marks..in
Signature of Dependent 8. Left thump Impresslon of Dependent

PART-II

hereby declare that the partlculârs glven above are true to the best of y
knowledge.
Place:
Date
Slgnature of Ex-Servlcemen /Wldows
PART-IV

Place
Date Slgnature.
ZSWO/Dlr, RSB
PART-V

Dependent ldentity Card No.. niValld up to ..

Demand Draft No
Date: (Slgnature)
Amount:
Bank Name Issulng Authorlty
 TERMSAND CONDITIONS; DEPENDENT.IDENTITY CARD
Ellglblty:Thls Card ls valld only for Alr Travel Concesslon. Thls card ls not valld
for access to restrlctod mlitary aroas.
Spouse(wife), dependent chlldren & paronta of
parents ofunmattlod soldlors who ate Ex-Sorvlcemen, Dependent
all sources Is below R3. kllöd In actlon/ war whose Incemo from
DO00/- P.M ato dliglblà
Dischargd Book /PPO only.If thelr names aro entered In

Validlty: () Spouso: Maximumm of 5 yoars only, to be

renewed thereafter
(1) Sorts: up to tho age of 26 yeure or tll omployed whlohover ls oarlior
or
unemployod dle to dløabllty for lfe tlme.
(1) Daughtere: Tll.marrlage or unomployed due to disabllty lfe tima.
(Iv) Perhanently Dlsalbled childror: Valld for
P
Charges: First lssue: Rs.100/- Per each Card. llfe time.
Renewal Charges due to falr wear &
toar aftor 5. years: Rs. 100/- card
Loss of ID card :
Dupllcale Card will be.lssued on submlsslon of per FIR,
along with photos, documents and penalty. Reglonal Salnlk Welfare applicatlon
Oficer wlil
Investlgate & Issue ID Caid after one month from
Ponalty for lssue of dupllgate 1D card: the date of FIR.
Flrst loss Rs. 300/
Second Loss Rs. 600/
Third Los9 Re. 900/
v) No ID oard wll be
lssued alter that.
Demand Draft In favour of "Director
Salnik Welfare, T.S.
Hyderabad"
Documents Roqulred
a) Application Form (Separate appllcatlon form for each
b) Passport Size Photo of dependent 03 coples (wlthapplicant).
Blue Back ground
without spectacles, wlthout
headgear, l.e, Cap,scarf, etc )
Original& Xerox Copy of Dlscharge book
Orlglnal & Xerox Copy of PPO.
Copy of B|rth Certlflcale or 10 Certlficate
) Copy of Aadhar card of Dependent. (SSC) of dependent.
Copy of Ex-Servlcemeh ID Card.

Detalls of deperident
ID.card wll be. endorsed on orlginal PPO/ Dlscharge book.
Photostat of I Caid is pröhlblted.
Misuse /Tampering of ID cards will
lead to
Dependent ID cards wll not be lssued case. If the
of benefits to Ex-Servicemen.
names
mentioned In Discharge book/PPO/Part lI order. of.Dependent are not
Dependent has to physlcally visit the office of Sainik Welfarb
roglstor for lssue of ID Card. and slgn In the
Dependent ID Cards wll have to be
Offlce after cxplry of validlty. surrenderod In Reglonal. Salnlk Welfare

hereby certlfy that I have

cohditlons and ayree lo thhøm. read.and-undrstood all the terms and

Place;
Date
(Slgndture of Bx-Servlgeman/Wldow)