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FINANCIAL ASSISTANCE FOR WAGE LOSS

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FINANCIAL ASSISTANCE FOR WAGE LOSS

DAMAN

FORM XV

FINANCIAL ASSISTANCE FOR WAGE LOSS

Submit*

Name of Beneficiary*

Date of Birth*

Age*

Gender*

Marital Status*

Mobile No.*

Aadhaar Number*

Temporary Address:

Address Line1*

Address Line2

Landmark*

Village/Town/City*

Taluka*

District*

State*

Pincode*

Permanent Address:

Address Line1*

Address Line2

Landmark*

Village/Town/City*

Taluka*

District*

State*

Pincode*

Other Details:

Date of payment of subscription*

No. of days rest advised by the Doctor*

Details of medical benefits received, if any before

Bank Details:

Bank Account Number*

Name of Bank *

Name Of Branch*

IFSC Code*

Submit*

Department Addresses

DNH Details

Old Circuit House Building,
Opp. Bal Bhawan, Silvassa,
Dadra and Nagar Haveli - 396230

0260 - 2642374

labour-dnh@nic.in

Daman Details

Vidhyut Bhavan, Kachigam,
Daman 396215

0260 - 2261059

lelidaman@gmail.com

Diu Details

Labour & Employment Office
Collectorate Diu 362520

02875 – 252444

Useful Links

Website QR Code

Last Update on Date: 15/03/2021