CASE APPLICATION

Atrocity Relief Application

Complete the form carefully, attach the required documents and submit your application.

Fields marked with an asterisk (*) are mandatory.

Applicant Details

Applicant Name

Father/Husband Name

Applicant Relation

Date of Birth

Gender

Religion

Case Details

State ( Police Station )

District ( Police Station )

Police Station

FIR Number

Date of FIR

Court

Judgment Date

Compensation Amount Related Details

NOTE : All Detail should be related to the Compensation Amount !

Enter the details only after confirming the Compensation amount received from your bank statement.
In case of non-receipt of Compensation amount, mention the details of the bank account in which the amount is to be received.

Bank Name

Account Number

IFSC Code

Amount Received

Date of Amount Received

Required Documents

Note: All submitted documents are required to be self-attested by the applicant.

FIR ( .pdf Only )

Aadhaar Card Front

Aadhaar Card Back

Caste Certificate

Domicile Certificate

Bank Statement

Copy of Judgement

Signature

Samagra Id

I Mr. Age Adult Resident District State I declare that the above information given by me is true to the best of my knowledge and belief, I have not concealed anything in it not there. I am aware that if I provide false or misleading information, all the benefits received by me will be withdrawn.

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