Andhra Pradesh: Chief Minister’s Relief Fund: PROFORMA-cum-REQUISITION Form and Sanction Process

The government has devised a quick and simple procedure for the person in distress to get urgent help — within 48 hours for Medical cases and within 15 days for Ex-gratia, from the time of raising alarm by knocking the government’s door.

A System has been evolved to process all the petitions received directly by Hon’ble CM. It takes care in giving timely relief in transparent way, by maintaining checks and balances, and maintaining records for any audit purpose.

 

Contact Information:

CM Relief Fund

C-Block, 5th floor,

A.P. Secretariat,

Hyderabad.

Telephone Nos : 040-23454434, 040-23454579, 040-23455662.

 

 

 

PROFORMA-cum-RE QUISITION                                                             

FOR SEEKING FINANCIAL ASSISTANCE

FOR MEDICAL TREATMENT/EXGRATIA UNDER

“CHIEF MINISTER’s RELIEF FUND”

To

 

The Hon’ble Chief Minister,

Govt. of Andhra Pradesh,

Hyderabad.

 

 

01. Name of the Patient/Beneficiary : __________________________

(with Surname)

 

02. Father’s/Husband’s Name : __________________________

 

03. Age : __________________________

 

04. Permanent Address:

 

H.No. : __________________________

Street/Village : __________________________

Mandal : __________________________

District : __________________________

Pin Code : __________________________

Phone No. (if any) : __________________________

 

05. Address for Correspondence:

 

H.No. : __________________________

Street/Village : __________________________

Mandal : __________________________

District : __________________________

Pin Code : __________________________

Phone No. (if any) : __________________________

 

06. Name of the Disease/Purpose for seeking : __________________________

exgratia/financial assistance

 

07. Name & Address of Hospital with Phone : __________________________

& Fax Number __________________________

 

08. Date of Surgery/Operation : __________________________

 

09. Estimated/Requested Amount (Hospital : __________________________

estimation in ORIGINAL to be enclosed)

 

10. Whether any amount was sanctioned under : Source __________Amount:Rs.

CMRF or from any other source

 

11. Ration Card/Income Certificate : ________________________

 

The above information given by me is true and correct as per my knowledge and I request you to sanction financial assistance under CMRF.

 

Yours faithfully

Place:

Date:

SIGNATURE OF THE PATIENT

Enclosures:

1. Hospital Estimate in original
2. Copy of White Ration Card/Income certificate issued by the MRO.

 

Source: Chief Minister’s Relief Fund-Andhra Pradesh

DOC/PDF files:

CMReliefFund-Proforma-Requisition.PDF

CMReliefFund-Proforma-Requisition.PDF