Application form for Advance protection from injuries for individual/group

Instructions:

  1. Download the application form by clicking here for Advance protection from injuries.
  2. In case of group application, add additional no. of rows in the table as per the requirement in the soft copy of the application form.
  3. Fill the applicant’s details only in the soft copy of the form. Do not change anything else.
  4. Take a printout.
  5. Fill the other details except “date of payment remitted” field.
  6. Get it attested by a govt official of the rank not less than district collector or equivalent. If the applicants are a member of a self-sufficient farm, attestation of that farm’s GM-Admin is required.
  7. Payment remittance in full. Total amount to be paid (in INR) = (INR 15 lakhs i.e., INR 15,00,000/- x no. of applicants x no. of years you wish to avail protection) + INR 100/- (towards application processing fee).
  8. After attestation and payment remittance, mention the “date of payment remitted” in the form
  9. Scan the attested form and save it.
  10. Upload it in the below form for applying for the scheme.