Hindustanwelfare

Service Name *

Applicant's Name *

S/D/W/o *

Name of Mother *

Name of Spouse *

Family Member *

Mobile No *

Email ID *

Gender *

DOB *

Pan No *

Aadhar No *

Address for Communication

Address 1 *

Address 2

Address 3

Pincode *

District *

State *

Nationality *

Are you living on Rent?*

Yes

Are you 18 years old?*

Yes

Whether your Family annual income under 1,00000 Rs.*

Yes

Whether you employed*

Yes

Whether Person with Disability*

Yes

Whether the family owns any house anywhere in India*

Yes

Whether you have any one document listed below as Proof of residence*

Whether you have any one document listed below as Proof of Age*

How much loan do you need?*

Loan Required For *

Bank Name *

Bank Account No. *

Bank IFSC Code *

Tenure For Loan *

Religion*

Category*

Educational Qualification*

Employment Status*

Marital Status*

Property Type*

In case of Tenant Rent Agreement [Affidavit] On 50 Rs. Stamp Paper (Download)–[You may ask at time of verification]

Income Affidavit On 10 Rs. Stamp Paper (Download)–[You may ask at time of verification]

(SELF DECLARATION)

I S/D/W/o that I hereby declare that the information provided in this Application Form is true and correct to the best of my knowledge and belief and I am aware that if any part of the data and information submitted is found to be false or misleading, The SAMITI can take any kind of action against me. I hereby declare that all statements made in this Application Form are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found suppressed or false or incorrect or ineligibility being detected before or after the verification, my Application Form is liable to be cancelled as per the provisions of the SAMITI Act-2023.

That I am a citizen of India. That I have neither acquired the citizenship of another country nor have surrendered or been terminated or deprived of my citizenship of India. I further declare that I fulfill all the conditions of eligibilities. I have read the provisions of the Notice of this application carefully and I hereby undertake to abide by them. I have not submitted any other application before. I am aware that if I contravene this rule my application will be rejected summarily by the SAMITI.

I do not have any criminal record. That no warrant or summons has been issued by any court of India against me. I do hereby solemnly and sincerely declare that I have never been convicted of any crime or offense and I am not involved in any kind of criminal or unlawful activity and no criminal or any unlawful activity case is currently pending against me.

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HINDUSTAN JAN KALYAN RASHTRIYA VIKAS SEWA SAMITI

Administrative Autonomous Organization under Govt. Of India
National Capital Territory of Delhi

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Services/financialservice

Finance Assistance Application Form

(All States of India)

PART-I

PART-II

Address for Communication

PART-III

PART-IV

(SELF DECLARATION)