Glden Breeze Foundation | Beneficiary Application Form

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Beneficiary Application Form

Golden Breeze Foundation - Humanitarian Aid

Applicant Details

Applicant's Aadhaar Number

Email Address

Applicant Name

Mobile Number

Applicant's Date of Birth

Applicant's Marital Status

UnMarried

Married

Divorced

Widow/er

Applicant's Father / Husband / Guardian's Name

Educational Qualification

Occupation

Monthly Family Income

Nature of Financial Request? (Loan/Donation/Others)

Address

Bank Account Details for Fund Transfer (If application is approved)

Representative Details (If Any)

Beneficiary's Representative Name

Beneficiary - Representative Relationship

Further Details for Application Processing:

Family Member Details (Name, Relationship, Age, Gender, Occupation, Monthly Income)

Is Beneficiary only Bread Earner?

Yes

Do you stay in own / Rented House?

Own

Rented

Do you own any Jewels?

Yes

Your Bank Balance

DO you have any insurance / mutual funds / FD ?(Value If Any)

If Rented House, mention monthly rental amount?

If YES,Jewels Value?

Land / Properties Value (If Any))

Annual Savings (After all expenditures). Balance value in Indian Rupees?

Acknowledgement

I acknowledge the above given information about me is true, I also understand that trust is not responsible directly or indirectly for the transactions / service / treatment provided by the hospital / institute.

Agree

Disagree

Signature of Beneficiary:

Signature of Representative:

Application Filled By: (Name)