Punjab Building And Other Construction Workers Welfare Board Application Form.pdf

1. Mode of Delivery of Service/ ਸੇਵਾ ਦੀ ਅਦਾਇਗੀ ਦਾ ਤਰੀਕਾ
□
Sewa Kendra / ਸੇਵਾ ਕੇਂਦਰ
□
By Post/ ਡਾਕ ਦੁਆਰਾ
2. Application processing Office / ਅਰਜੀਕਾਰਵਾਈਦਫ਼ਤਰ

Service Details / ਸੇਵਾ ਦਾ ਵੇਰਵਾ
3. Registration Number

4. Name of the Beneficiary

5. Father’s name

6. Address

7. Contribution paid up to

8. Type of Work
9. Mobile No.

General Information
10. Name of Child

11. Age

12. Financial year for which benefit is being claimed
If the Benefit received earlier give details
13. Name of Child

14. Financial year for which benefit received

15. Date of Receipt

16. Amount

Banking Detail
17. Bank Name

18. Branch Name

19. Account No.

20. IFSC No.




Signature of beneficiary

Part -3 List of Required Documents / ਜ਼ਰੂਰੀ ਦਸਤਾਵੇਜ ਦੀ ਸੂਚੀ. Please tick (√) the document attached / ਿਕਰਪਾ ਕਰਕੇ ਨੱਥੀ ਦਸਤਾਵੇਜ ਨੂੰ ਿਟੱਕ (√) ਕਰੋ

1
Photo of Mentally Retarded/ Handicapped child(Joint
photo Beneficiary and Child)
Mandatory
2
Scanned copy of Medical certificate issued by Civil
Surgeon
Mandatory

I confirm that I have been residing in India for at least 182 days in the preceding 12 months & information
(including biometrics) provided by me to the UIDAI is my own and is true, correct and accurate. I am aware that
my information including biometrics will be used for generation of Aadhaar and authentication. I understand that
my identity information (except core biometric) may be provided to an agency only with my consent during
authentication or as per the provisions of the Aadhaar Act. I have a right to access my identity information
(except core biometrics) following the procedure laid down by UIDAI.


Citizen’s Signature / ਿਬਨੈਕਾਰ ਦੇ ਹਸਤਾਖਰ

Feed Back Form/ ਫੀਡਬੈਕ ਫਾਰਮ

1. Is there any unnecessary information being asked in the Form?/ ਕੀ
eh ਫਾਰਮ ਿਵੱਚ ਕੋਈ ਵੀ ਬੇਲੋੜੀ ਜਾਣਕਾਰੀ ਮੰਗੀ ਗਈ ਹੈ <
□
Yes / ਹ
□
No / ਨਹ€
If Yes, Please specify the detail/ ਜੇਕਰ ਹ, sK ਵੇਰਵਾ fdT[

2. Is any vague information being asked in the form?/ ਕੀ ਫਾਰਮ ਿਵੱਚ eh
eh ਕੋਈ ਵੀ ਅਸਪ©ਟ ਜਾਣਕਾਰੀ ਮੰਗੀ ਗਈ ਹੈ <
□
Yes / ਹ
□
No / ਨਹ€
If Yes, Please specify the details/ ਜੇਕਰ ਹ, sK ਵੇਰਵਾ fdT[
3. Is the space provided in the form sufficient for filling up the
required information?/ ਕੀ ਫਾਰਮ ਿਵਚ ਮੁਹੱਈਆ EK b'VhAdh ਜਾਣਕਾਰੀ ਭਰਨ ਲਈ
ਕਾਫ਼ੀ ਹੈ
□
Yes / ਹ
□
No / ਨਹ€
If No, Please specify the details/ ਜੇਕਰ ਨ, sK ਵੇਰਵਾ fdT[
4. Any other suggestion you may like to make, Please specify / ਕੋਈ ਹੋਰ ਸੁਝਾਅ ਦੇਣਾ ਚਾਹੁੰਦੇ ਹੋਤਾ ਵੇਰਵਾ fdT[