Ayushman Beneficiary

Family Member Details

If no family member detail given by beneficiary then select checkbox

No. of Family Members
(Other than Applicant) * Please enter Number only

Relation * {{msg1}}

Member's First Name * Please enter english characters only

Member's Middle Name Please enter english characters only

Member's Last Name Please enter english characters only

Gender * Male Female Transgender

Date of Birth *

Year *

Adhaar Card Number *

Please enter 4 digit Aadhar Number Please enter 4 digit Aadhar Number Please enter 4 digit Aadhar Number

Sr. No	Relation	Gender	Name of Member	Date of Birth	Adhaar Card Number	Delete
{{$index+1}}	{{item.RelationType}}	{{item.MemberGender}}	{{item.MemberFirstName}} {{item.MemberMiddleName}} {{item.MemberLastName}}	{{item.MemberDOB\| date:"dd/MM/yyyy"}} {{item.MemberDOBYear}}	{{item.MemberAadhaar1}}-{{item.MemberAadhaar2}}-{{item.MemberAadhaar3}}

{{AayushmanModel.Formtype}} Details

Note:{{DateMessage}}

Choose * J Form Sugarcane Slip

Market Committee *

Sugar Mill Name *

Mandi Yard *

Aartiya Firm Name(For J Form) *

Aartiya Firm Name(For J Form) * Please enter english characters only

{{LblFormNumber}}*

{{LblFormDate}} *

Document's Uploader

Note:Only .JPEG,.JPG,.PNG formats and maximum 500KB file size are allowed.

Beneficiary Documents

Upload Manual Filled Form* You Can Upload jpeg, jpg, png Images File size must be less than 500 KB

Copy of Adhaar Card* You Can Upload jpeg, jpg, png Images File size must be less than 500 KB

Copy of Adhaar Card

{{AayushmanModel.Formtype}} Copy * You Can Upload jpeg, jpg, png Images File size must be less than 500 KB

Member Documents

Sr. No	Relation	Name of Member Member	Adhaar Card Number	Upload Adhaar Card
{{$index+1}}	{{item.RelationType}}	{{item.MemberFirstName\|titleCase}} {{item.MemberMiddleName \|titleCase}} {{item.MemberLastName \|titleCase}}	{{item.MemberAadhaar1}}-{{item.MemberAadhaar2}}-{{item.MemberAadhaar3}}	You Can Upload jpeg, jpg, png Images File size must be less than 500 KB

Personal Data of 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

{{AayushmanPreviewModel.CityVillage==1?'Town/City':'Village'}}

Region

Address/House No/Street No

Pin Code

Family Member Details

No family member detail given by beneficiary

No. of Family Members

Sr. No	Relation	Gender	Name of Member	Date of Birth	Adhaar Card Number
{{$index+1}}	{{item.RelationType\|titleCase}}	{{item.MemberGender\|titleCase}}	{{item.MemberFirstName\|titleCase}} {{item.MemberMiddleName\|titleCase}} {{item.MemberLastName\|titleCase}}	{{item.MemberDOB \| date:"dd/MM/yyyy"}} {{item.MemberDOBYear}}	{{item.MemberAadhaar1}}-{{item.MemberAadhaar2}}-{{item.MemberAadhaar3}}

{{AayushmanPreviewModel.Formtype}} Detail

Sugarcane Mill Name

Market Committee

Mandi Yard

{{LblFormNumber}}

{{LblFormDate}}

Aartiya Firm Name(For J Form)

Form Type

Document's Uploader

Beneficiary Documents

Upload Manual Filled Form

Copy of Adhaar Card

{{AayushmanPreviewModel.Formtype}} Copy

Member Documents

Sr. No	Relation	Name of Member	Adhaar Card Number	Upload Adhaar Card
{{$index+1}}	{{item.RelationType\|titleCase}}	{{item.MemberFirstName\|titleCase}} {{item.MemberMiddleName \|titleCase}} {{item.MemberLastName \|titleCase}}	{{item.MemberAadhaar1}}-{{item.MemberAadhaar2}}-{{item.MemberAadhaar3}}