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Duare Tran Prakalpa Application Form Evergreen Tutorial

This document is an application form for "Duare Tran", a relief program run by the Government of West Bengal. [1] It collects basic information about the applicant such as name, gender, address and contact details. [2] It also collects details of the applicant's identity documents and bank account. [3] The main section allows the applicant to specify the type of relief assistance needed, such as compensation for crop damage, home damage or livestock loss due to a disaster. A list of required documents to be submitted with the application is also included.

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sujit patra
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60 views2 pages

Duare Tran Prakalpa Application Form Evergreen Tutorial

This document is an application form for "Duare Tran", a relief program run by the Government of West Bengal. [1] It collects basic information about the applicant such as name, gender, address and contact details. [2] It also collects details of the applicant's identity documents and bank account. [3] The main section allows the applicant to specify the type of relief assistance needed, such as compensation for crop damage, home damage or livestock loss due to a disaster. A list of required documents to be submitted with the application is also included.

Uploaded by

sujit patra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GOVERNMENT OF WEST BENGAL

APPLICATION FOR “DUARE TRAN”


Unique Registration No.

Basic Information
1 Name of the applicant
2 Gender of the applicant M F O
Name of co-applicant from the family (if
3
any)
4 Relation of co-applicant with the applicant
5 Contact Mobile No. of the applicant
6 Alternate Mobile No.
7 Category: SC ST GEN
Full Address: District, Block/ULB,
GP/Ward, Address
8
Aadhaar No. of the applicant
Khadyasathi No. for family
Krishak Bandhu Number
Fisherman Card Number
9
Artisan Card Number
MGNREGS (100 days’ work) Job Card Number

(ID numbers are to be entered for applicant as well as co-applicant)

Bank Account Details:-


1 Bank Name
2 Branch Name
3 IFSC Code
4 Account No.

Details of Relief Assistance being Applied for:


Details (Tick as applicable or mention To be verified by the
SN Relief applied for
number) inspection team (Y/N) *
1 Crop damage (mention Less than 1 More
area of farm for loss of acre (mention than 1
crop) area) acre
2 Damage to Dwelling unit Partially Fully
3 Livestock loss Numbers claimed: Actual Nos. observed:
i. Cow:
ii. Buffalo:
iii. Goat:
iv. Sheep:
v. Calf:
vi. Pig:
vii. Bullock:
viii. Duck/
Poultry
4 Damaged betel-vine Yes No
structure
5 Hundi(s) lost Numbers claimed: Actual Nos. observed:
Repair/replacement of Partially Fully
damage to Boat
Net(s) lost Numbers claimed: Actual Nos. observed:
6 Replacement of damaged Yes No
equipment for artisan
For loss of raw Yes No
materials/goods in
process/finished goods
for damaged work sheds, Yes No
godown, showrooms

(* - To be filled up by the composite enquiry team at the time of inspection)


• List of Documents submitted:

Sl. Documents Yes No


1. Aadhar Card of the applicant - Photocopy
2. Khadya Sathi Card Photocopy
3. Address Proof (Voter ID/PAN/any other valid Address proof)
4. Bank Account Statement/Passbook Photocopy
5. Krishak Bandhu Card Photocopy
6. Fisherman Card Photocopy
7. Artisan’s Card Photocopy
8. NREGA Job Card Photocopy

Date: Signature of Applicant/Thumb impression


Place:

For Composite Field Enquiry Team:


Date of Inspection:

Signature(s) of enquiry team member(s)

For Sanctioning/Approving Authority


Recommendations Approved / Rejected:

Date:

Signature of Approving Authority

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