District Social Welfare Grant Application Form

To submit the application form, please contact your local District Social Welfare Office. You can submit the form via email at socialwelfare@example.com or by fax to (123) 456-7890. Alternatively, you may also submit the hard copy of the form at the district office located at 123 Welfare Lane, City Town.

For the year 2024, all applications must be submitted by June 30th and December 31st to be considered for funding support. Similarly, for 2025, ensure that applications are filed by June 30th and December 31st. Keep track of these dates to secure timely processing of your requests.

The primary purpose of this application form is to assist individuals with disabilities in obtaining necessary prosthetic aids. It facilitates the process of applying for financial support from the District Social Welfare Department. This form also serves to document the medical need for such aids, ensuring applicants receive appropriate assistance.

• 1. Name: Full name of the applicant.
• 2. Parentage: Details about the applicant's parents or guardians.
• 3. Residence: Current address of the applicant.
• 4. Occupation: Job title or occupation of the applicant.
• 5. Family Income: Monthly income of the applicant's family from all sources.
• 6. Type of Handicapped Diseases: Specify the disability or diseases affecting the applicant.
• 7. Kind of Orthopedic Appliance Required: Indicate the specific prosthetic appliance needed.
• 8. Institution for Treatment: Name and address of the institution providing the treatment.
• 9. Approximate Cost: Estimated cost of the required prosthetic aid.
• 10. Charges: Additional costs charged for treatment.
• 11. Signature of the Applicant: Signature indicating agreement of the details provided.
• 12. Medical Certificate: Certification by a medical professional regarding the applicant's condition.
• 13. Income Certificate: Document certifying the family's income.
• 14. Verification by District Officer: Signature of the district officer verifying the application.

Failure to submit this application form may result in missing out on essential prosthetic aid. Applicants will not be able to receive financial assistance for their medical needs. It is crucial to adhere to submission guidelines to ensure adequate support.

• Funding Delays: Without submission, funding for necessary aids may be postponed.
• Lack of Medical Support: Applicants may miss the opportunity to receive needed medical assistance.
• Ineligibility for Grants: Late or missing submissions could lead to ineligibility for financial grants.

• 1. When Applying for Medicinal Aids: Use this form if you need support for orthopedic appliances.
• 2. To Certify Disability Claims: It serves to support claims regarding medical conditions.
• 3. For Family Assistance: Families seeking grants for disabled members must fill out this application.