Claim Form
Registration No
Aadhaar Number
First Name
Father/Husband Name
Last Name
Mobile
Bank Details
IFSC
Bank Name
Branch
Bank Address
Account No
Select Center
Center 1
Center 2
Select Scheme Category
Scheme A
Scheme B
Documents
Bonafide
Child Aadhaar
Passbook
Ration Card
I declare the information is true
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