Application For Marriage Incentive

Details of Person with Disability(Spouse)

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Details of Other Person (Spouse)

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Couple Residence Address

Date and Place of Marriage

Certificate Enclosed (Self Attested Copies)

i. Disability Certificate Issued by District Medical Board as notified by the Government : Yes No
ii. Marriage Registration Certificate issued by the competent Registration Authority of Marriages : Yes No
iii. Residential certificate issued by the Tahsildars/Residential proof Yes No
iv. Proof of joint account of husband and wife along with Bank authorization for e-transfer of the fund Yes No

We certify that the information furnished are true and correct. We also certify that we have not claimed the Marriage Incentive Award previously. If in any case, the information submitted by us are proved to be wrong at any time, we understand we are liable for prosecution entailing of Rs. 1,00, 000/-, imprisonment up to 2 years and recovery of Marriage Incentive Award paid along with 12% interest thereon.