AFVOA Newletters of Year 2010

Page 45 of 50 Date Amount (Rupees) Bank Name 11. (a) Physical Disability ( ✓ ) (b) War Disability ( ✓ ) Please attach relevant documentary proof Date Signature of Applicant Applicants to retain photocopy of this form duly receipted by polyclinic/Stn HQ/Regional Centre. PTO In case any changes required to the existing details please specify eg change of parent polyclinic, change of address and deletion of beneficiary due to death, marriage, over 25 age (son) & employment etc. Ser No Changes required Reason Note :-1. The Cost of upgraded ECHS Cards will be paid @ Rs 135/- per card through DD in favour of dependent Regional Centre ECHS 2. War disabled will be provided with white cards. 3. The application alongwith DD in favour of dependent Regional Centre