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Form P

This document is a pension information form used to collect personal and financial details for applicants seeking social welfare pensions from the Department of Women and Child Development & Social Welfare in West Bengal, India. The 3-page form collects identifying information like name, date of birth, address, disability details if applicable, income, bank account information, and required documents. It is used to process both new pension applications and changes to existing pensions for eligibility under categories like old age, disability, or widow pensions. Applicants must provide mandatory information and documents for processing and approval by reviewing officials.

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Faisal Moazzam
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281 views2 pages

Form P

This document is a pension information form used to collect personal and financial details for applicants seeking social welfare pensions from the Department of Women and Child Development & Social Welfare in West Bengal, India. The 3-page form collects identifying information like name, date of birth, address, disability details if applicable, income, bank account information, and required documents. It is used to process both new pension applications and changes to existing pensions for eligibility under categories like old age, disability, or widow pensions. Applicants must provide mandatory information and documents for processing and approval by reviewing officials.

Uploaded by

Faisal Moazzam
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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Form-P

Acknowledgement No.

Department of Women and Child Development &


Social Welfare Passport Size
Government of West Bengal Picture

PENSION INFORMATION FORM (Form-P) [To be filled up English Block Capitals Only]

Pension Case*: Existing New

Type of Pension*: Old Age Disability Widow

PERSONAL DETAILS
1. Aadhaar No.: - -
2. Voter ID No.:
First Middle Last
3. Name of Beneficiary*:
4. Gender*: Male Female Other
5. Date of Birth*: / / / Age:
First Middle Last
6. Father’s Name*:
First Middle Last
7. Mother’s Name*:
8. Religion*: Hinduism Islam Christianity Others
9. Caste*: SC ST OBC General
10. Spouse(Husband/Wife): Dead Alive (Spouse name mandatory if alive) Not Applicable
First Middle Last
11. Spouse Name*:
12. Monthly Family Income:

CONTACT DETAILS

1. House/Premise No.:
2. Village/Town/City*:
3. GP/Ward No. *:
4. Block/Municipality*:
5. Police Station:
6. Post Office*:
7. Sub-Division*:
8. District*:
9. PIN*:
10. State*: W E S T B E N G A L

11. Mobile No.: + 9 1

12. Landline No.:


13. E-mail ID:

Acknowledgement Copy
Acknowledgement No.: Date: / /

Name:
Type of Pension: Old Age Disability Widow

Date: Signature of Receiver with Stamp


Designed by NIC-WBSC Version: 1.05 Page 1 of 2
FOR DISABILITY PENSION
1. Type of Disability: OH [Orthopedically Handicapped] VH [Visually Handicapped]

HH [Hearing & Speech Handicapped] MI [Mentally Illness]

MR [Mental Retardation] MD [Multiple Disabilities]

LC [Leprosy Cured]

2. Percentage of Disability:
3. Issuing Authority:

BANK ACCOUNT DETAILS

1. Bank Name*:
2. Branch*:
3. Account No.*:
4. IFS Code*:

ENCLOSURE LIST

1. Copy of Aadhaar self-attested: 2. Copy of Voter Id:


3. Copy of Ration Card: 4. Copy of Disability Certificate:
5. Copy of Income Certificate: 6. Copy of Husband’s Death Certificate:
(For widow pension)
7. Copy of Bank Pass Book:
8. Nomination Form (In case of death):
9. Others, please specify
Declaration: If Aadhaar card has been provided.
I give / do not give consent to the use of the Aadhaar number for authenticating my identity for social
welfare pension.

Date: Beneficiary Signature


* Marked fields are mandatory.
-------------------------------------------------------------------------------------------------------------------
For office use only
1. Acknowledgement No.
2. Applicant ID:
3. Reviewer/Approver Name:
4. Reviewer/Approver Designation:

Date: Signature with Stamp of Reviewer / Approver

Designed by NIC-WBSC Version: 1.05 Page 2 of 2

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