Death Claims | National Foundation For India

Name of the deceased NGO Workers/Volunteers *

Name of the NGO and Address *

Name of the claimant *

Last Drawn Salary

Father’s/Mother’s Name of the deceased

Sex *

Occupation Claimant

Photo of Deceased

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

Claimant Address *

District/Village *

PIN *

Phone No. *

Name of the treating doctor

Name of the hospital (if admitted)

Date of Death *

Covid test done *

Yes

No

Insurance status *

Yes

No

Have received money from any other sources *

Yes

No

If Yes

Name of Head of the NGO referring case

Upload the document

Death certificate *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

COVID test report ( if available)

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Aadhar/PAN/Driving licence for identification *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Pan Card of the claimant *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Proof of being a worker during the COVID period (Preferred Attendee/Bank statement)

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Proof of dependent/certificate/affidavit *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Reference letter of NGO where person worked/served *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

declare

I hereby declare that the information provided is true and correct. I also understand that any wilful dishonesty may render for refusal of this application or immediate termination of employment