SSEPD::Social Security & Empowerment of Persons With Disabilities Department

National Family Benefit Scheme (NFBS)

Details Of Deceased Person

Pension Type

Name of Deceased Person

Father's/Mother's Name

Husband's/wife's Name

Gender

DOB

Proof Of Age

District

Block/Municipality

BPL / Income Certificate Number

Upload BPL / Income Certificate Document

Social Category(Caste)

Disability Type

Upload Disability Document

Disability Percentage

Occupation

Marital Status

Details Related To Death

Date Of Death

Nature of Death

Reason Of Death

Death Certificate Number

Upload Death Certificate(Please remove all special characters from file name)

Details of Dependents Of Deceased:

SL no.	Name	Age	Relation to the Deceased	Action
1

Details Of Applicant

Name as per Aadhaar

Gender

DOB

AGE

Relationship with Deceased

Aadhar Number

Aadhar Scan Copy

Father's/Mother's Name

Husband's/wife's Name

Mobile Number

Additional Document

Photo

Upload Image
(.JPG/.JPEG Format is Allowed)

Bank Account Details

Bank Account Type

Account Holder Name

Account Number

Choose IFSC Code

Choose Branch

Upload Bank Passbook/Statement(PDF Only)

Upload Signature/Thumb Impression Of Applicant(PDF Only)

Declaration

I/We declared by this, we are included under scheduled criteria for poverty by Indian government.

Back