Smt.

Saraswati Devi Shivkishan Damani Foundation

Supporting Women Towards Empowerment
Application Form
Please fill up the Application Form yourself Stick a
Passport Size
Photo of self
1) Full name of the applicant: ................................................................................
2) Date of birth: ……/……/……/……/……/……/……/……/ Age: ………………….
3) Educational Qualification: ...................................................................................
Marital Status:
4) Your Mobile/phone No.: ……/……/……/……/……/……/……/……/……/……/ Single ⃝
5) Your WhatsApp Number: ……/……/……/……/……/……/……/……/……/……/ Married ⃝
6) AADHAR Card No. ……/……/……/……/……/……/……/……/……/……/……/……/ Divorced ⃝
[Please enclose AADHAR card copy] Widow ⃝
7) E-mail ID: ………………………………………………………………………………..……………………… Separated ⃝

8) Home address: ..............................................................................................................

............................................................................................................................. ..................................................
Village/Town/City: .............................................................. Post office: .............................................................
State: …………................................................................ PIN Code: ……/……/……/……/……/……/

8) Where do you live?: Own home [ ]; With Son [ ]; With Daughter [ ]; With Parents [ ]
10) Type of House: [ ] Ownership [ ] Rental
11) Full name of Husband: ...................................................................................................................
Phone/Mobile No.: ……/……/……/……/……/……/……/……/……/……/
12) If divorced - date of divorce: ……/……/……/……/……/……/……/……/ [ ] Not Applicable
13) If widow - date of husband's death: ……/……/……/……/……/……/……/……/ [ ] Not Applicable
14) Full name of Father: .......................................................................................................................
Father’s Address: ………………………………………………………………………………………………………………….
………………………………………………………………..……………………………………………………………………………
Phone/Mobile No.: ……/……/……/……/……/……/……/……/……/……/
15) Current occupation: Employed [ ]; Own small business [ ]; Homemaker [ ]
16) Languages known:
1) Hindi: Yes [ ]; No [ ]
2) English: Yes [ ]; No [ ]
3) Other: ………………………………………………………………………………………………………………………………..
18) Details of family members (including children):
Name of family member Date of Birth M/F Relation Living with Education/Class
you
YES NO
1.
2.
3.
4.
5.
6.
7.
19) Complete details of any financial assistance received from any government/institution/Samaj:
1) ……………………………………………....................................................................................................................
20) Complete details of pension, if receiving on behalf of husband/self:
1) ..………………………………………………………………….…………..……………………………………………………………………………
Bank details of the applicant:

Bank Name: ..................................................................................................................................................

Branch Address: ..........................................................………………………………………………………………………………
Account Number: .......................................................................

IFSC: /....../....../....../....../....../....../....../....../....../....../....../ [Please enclose Cancelled Cheque]

Is your bank account joint? Yes [ ]; No [ ] If yes, who is the other a/c holder: ..........................................
Who operates your bank account?: ............................................ His/her Mobile No.:..................................

20) Please provide details of a relative who does not live with the applicant:
Name: .......................................................................................................... Relation: ………...................................
Address: ...............................................................................................................................................................
..................................................................... Relative’s Mobile No. ……/……/……/……/……/……/……/……/……/……/
I, the applicant hereby solemnly affirm that the information provided herein above is true, and I request your
trust for financial help.

.................................. ...................................................
Date Signature of the applicant
Copy of Documents attached: (Please tick)
□ Aadhar card □ 1st page or Bank Passbook/ Cancelled Cheque □ Medical reports (if any) □ Disability Card
□ Husband’s Death Certificate / □ Divorce Decree / □ Missing report (as applicable)
………………………………………………………………………………………………………………………………………………………………………………
Saraswati Devi Shivkishan Damani Foundation
Hoechst House (7th floor), NCPA Marg, Nariman Point, Mumbai 400021,
Maharashtra(Mobile No. 022 41770000 (7066)/9004176398)
Email: [email protected]