DEPARTMENT OF REVENUE
GOVERNMENT OF NCT OF DELHI
DELHI RIOTS - RELIEF & REHABILITATION
APPLICATION FORM FOR CLAIM FOR COMPENSATION
     Language :: हिंदी

10. Details of other family members living in the above address, if claim is filed for them also

S No. Name Relationship with the claimant Age Aadhaar/Voter Id Number Status of the injured*  
   Add   
Status of the Injured :: (1) Permanent incapacitation (2) Serious Injury (3) Minor Injury(...) etc.

11 a. Details of loss in business

Address Type of business(Shop/rehri/etc) Extent of loss
   Add   

b. Details of damage to house, if any (Owner/tenant)

Address Extent of loss
   Add   

c. Details of damage to e-rickshaw/Rickshaw (if any)


d. Particulars of the deceased (if any)

Name Age Address Relation with the claimant
   Add   

Details of Bank Account

Name of the Bank Account No. MICR Code IFSC Code