Fisherimen Welfare Schemes

APPLICATION FOR REGISTRATION IN SAVING CUM RELIEF SCHEME

State*

District*

Fishing Area*

Activity Type*

Fisherman Allied Worker

Reg No:. *

Applicant Name *

Address *

Phone Number*

Date Of Birth*

Age*

Annual Income(Rs)

Category*

Bank Name *

Branch Name *

Account Number*

IFSC Code*

Family Member *

Relation*

House No./Name*

State*

District*

PIN*

Annual Subscription Details Available*

Yes No

Receipt No

Date

Amount