Aayushman Beneficiary

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

{{msg}}

Date of Birth *

OR

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

{{msg3}}

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}} *

{{DateMessage}}

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

{{AayushmanPreviewModel.BenificaryFirstName |titleCase}}

Beneficiary's Middle Name

{{AayushmanPreviewModel.BenificaryMiddleName |titleCase}}

Beneficiary's Last Name

{{AayushmanPreviewModel.BenificaryLastName |titleCase}}

Gender

{{AayushmanPreviewModel.Gender |titleCase}}

Father's/Husband First Name

{{AayushmanPreviewModel.FatherFirstName |titleCase}}

Father's/Husband Middle Name

{{AayushmanPreviewModel.FatherMiddleName |titleCase}}

Father's/Husband Last Name

{{AayushmanPreviewModel.FatherLastName |titleCase}}

Beneficiary's Date of Birth

{{AayushmanPreviewModel.BenificaryDOB | date:"dd/MM/yyyy"}}

{{AayushmanModel.BenificaryDOBYear}}

Mother's First Name

{{AayushmanPreviewModel.MotherFirstName |titleCase}}

Mother's Middle Name

{{AayushmanPreviewModel.MotherMiddleName |titleCase}}

Mother's Last Name

{{AayushmanPreviewModel.MotherLastName |titleCase}}

Beneficary's Aadhaar Card

{{AayushmanModel.BenificaryAadhaarprev}}

Grandfather's First Name

{{AayushmanPreviewModel.GrandfatherFirstName |titleCase}}

Grandfather's Middle Name

{{AayushmanPreviewModel.GrandfatherMiddleName |titleCase}}

Grandfather's Last Name

{{AayushmanPreviewModel.GrandfatherLastName |titleCase}}

Beneficiary's Contact Number

{{AayushmanPreviewModel.ContactNumber}}

Marital Status of Beneficiary

{{AayushmanPreviewModel.MaritalStatus |titleCase}}

District

{{AayushmanPreviewModel.DistrictName |titleCase}}

Tehsil

{{AayushmanPreviewModel.CityName |titleCase}}

Block

{{AayushmanPreviewModel.Block |titleCase}}

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

{{AayushmanPreviewModel.VillageName |titleCase}}

Region

{{AayushmanPreviewModel.Region=='U'?'Urban':'Rural'|titleCase}}

Address/House No/Street No

{{AayushmanPreviewModel.HouseNumber}}

Pin Code

{{AayushmanPreviewModel.Pincode}}

Family Member Details

No family member detail given by beneficiary

No. of Family Members

{{AayushmanPreviewModel.MemberCount}}

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

{{AayushmanPreviewModel.SugarMillName|titleCase}}

Market Committee

{{AayushmanPreviewModel.MarketCommitteeName |titleCase}}

Mandi Yard

{{AayushmanPreviewModel.MandiName|titleCase}}

{{LblFormNumber}}

{{AayushmanPreviewModel.FormNumber}}

{{LblFormDate}}

{{AayushmanPreviewModel.FormDate| date:"dd/MM/yyyy"}}

Aartiya Firm Name(For J Form)

{{AayushmanPreviewModel.LicenseName|titleCase}}

Aartiya Firm Name(For J Form)

{{AayushmanPreviewModel.FirmName|titleCase}}

Form Type

{{AayushmanPreviewModel.Formtype=='1'?'JFORM':'Sugarcane Slip'}}

Document's Uploader

Beneficiary Documents

Upload Manual Filled Form

Copy of Adhaar Card

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}}