Aayushman Beneficiary

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Ayushman Beneficiary

Beneficiary's First Name

Beneficiary's Middle Name

Beneficiary's Last Name

Gender

Father's/Husband First Name

Father's/Husband Middle Name

Father's/Husband Last Name

Beneficiary's Date of Birth

Mother's First Name

Mother's Middle Name

Mother's Last Name

Beneficary's Aadhaar Card

Grandfather's First Name

Grandfather's Middle Name

Grandfather's Last Name

Beneficiary's Contact Number

Marital Status of Beneficiary

District

Tehsil

Block

Village

Region

Rural

Pin Code

No family member detail given by beneficiary

No. of Family Members

Sr. No	Relation	Gender	Name of Member	Date of Birth	Adhaar Card Number

Market Committee

Mandi Yard

J Form Number

J Form Date

Aartiya Firm Name(For J Form)

Form Type

Sugarcane Slip

Beneficiary Documents

Upload Manual Filled Form

Copy of Adhaar Card

Member Documents

Sr. No	Relation	Name of Member	Adhaar Card Number	Upload Adhaar Card