COVID19ExG

Instructions

Note: Claimant needs to upload signed copy of the form also which can be downloaded from here.

Details of deceased person

Name of deceased due to covid

S/o,W/o,D/o

State/UT

District

Tehsil

Village

Date of Death

Place of death due to Covid-19

No.date of Covid-19 Death Certificate

Covid-19 Death Certificatepdf max size: 500KB

Details of Claimant

Photograph of Claimant Max: 300KB (jpg/png only)

Name of claimant

S/o,W/o,D/o

Contact No. of Claimant

Relationship with deceased

No.date of Legal Heirship/Adoption deed

Legal Heirship/ Adoption deed pdf max size: 500KB

State/UT

District

Tehsil

Village/Ward

Aadhaar No. linked with Bank Account

Aadhaar pdf pdf max size: 500KB

Account No.

IFSC Code

Bank Passbook pdf pdf max size: 500KB

Address proof type

No.date of Address proof

Address Proof of Claimant pdf max size: 500KB

Signed Ex Gratia Application form pdf max size: 500KB