BOCW Department

DIU

FORM II

MATERNITY BENEFIT

Eligible Criteria:

Enrollment of beneficiaries under the Pradhan Mantri Jan Arogra Yojna i.e "Ayushman Bharat".
Rs.30,000/-per delivery for upto two deliveries to the registered male member.
Rs.40,000/-per delivery for upto two deliveries to the registered female member.

Any registered worker can make an application in the prescribed Form-II shall be submitted to the Member Secretary (BOCWWB) for this benefit: provided that this benefit shall not be allowed for more than two children. The Board may sanction the amount if found eligible.

Submit*

Name of Beneficiary*

Name of Husband*

Date of registration*

Date of Birth*

Age*

Date of confinement*

Gender*

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*

Date of First Subscription*

Amount of First Subscription*

Date of Last Subscription*

Amount of Last Subscription*

Have you applied for this benefit before*
Yes
No

(a) Copy of challans or pass book

(b) Medical Certificate original

Bank Details:

Bank Account Number*

Name of Bank *

Name Of Branch*

IFSC Code*

Submit*

MATERNITY BENEFIT

DIU

MATERNITY BENEFIT

Department Addresses

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