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Purpose of raising funds
Select Purpose of raising funds
Name
Address
Contact Number
Amount Required (₹)
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Medical Aid Details
Name of Patient
Who is the earning member of family (details)
Is there any medical insurance?
Is there any medical insurance?
Any support from family, friends, or organisations?
Any support from family, friends, or organisations?
Applied for Government funds under BPL Scheme?
Applied for Government funds under BPL Scheme?
Monthly Family Income (₹)
Medical Status of Patient (brief)
Hospital / Treatment Center Name
Applied for Mahatma Jyotiba Fule Yojana?
Applied for Mahatma Jyotiba Fule Yojana?
CM Fund applied or not
CM Fund applied or not
Is the patient a student?
Is the patient a student?
Upload Patient Photo
Upload Patient Photo
Upload Aadhaar Card
Upload Aadhaar Card Copy
Family Photo
Upload Family Photo
Upload Medical Reports & Hospital Estimate
Medical Reports & Hospital Estimate
Any other information you want to share
Upload SSC, HSC and Previous Mark Sheets
SSC, HSC and Previous Mark Sheets
Education expense certificate for current year
Education expense certificate for current year
Upload Income Certificate
Income Certificate
Student Photograph
Student Photograph
Family Photograph
Family Photograph
income breakup of individual family members
Receiving any other scholarship or support?
Receiving any other scholarship or support?
Expense breakup for current educational year
Any other information you want to share
Type of Assistance
Any Other Information
Description of Requirement
Supporting Documents
Supporting Documents
Submit
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