ServicePlus- Disaster Relief Assistance Service

GOVERNMENT OF PUDUCHERRY

DEPARTMENT OF REVENUE AND DISASTER MANAGEMENT

PUDUCHERRY STATE DISASTER MANAGEMENT AUTHORITY

Disaster Relief Assistance Application

Disaster Details

Disaster Type *

Disaster Name

Date of Disaster

Disaster Relief Assistance *

Property Damage

Deceased Member

Are you the owner of the damaged house? *

Own House

Rented House

Are you a legal family member of the deceased? *

Yes

No

Have you applied for the Rajiv Gandhi Social Security Scheme for Poor Families (2012) Form A *

Yes

No

Disaster

Untitled

Applicant Details

Applicant Name *

Address *

Father / Husband Name *

District *

Gender *

Male

Female

Transgender

Taluk *

Occupation

Revenue Village *

Mobile Number *

State *

Voter ID

Pincode

Ration Card *

Voter ID

Govt. Issued ID Card *

Ration Card * Only PDF, JPG, JPEG, PNG files allowed. Max size: 1MB.

Govt. Issued ID Card * Only PDF, JPG, JPEG, PNG files allowed. Max size: 1MB.

Bank Pass Book (FrontPage) * Only PDF, JPG, JPEG, PNG files allowed. Max size: 1MB.

Applicant Bank Details

Bank Account No. *

Confirm Account No *

IFSC code *

Confirm IFSC code *

Bank Name

MICR No

Damaged House Details

House Owner Name

Hut: A very simple shelter made from natural materials.

Occupation

Kutcha House: A temporary house made with weak materials.

Damaged House No *

Pucca House: A permanent house made with strong materials

Street Name *

House Type * Hut: A very simple shelter made from natural materials.
Kutcha House: A temporary house made with weak materials.
Pucca House: A permanent house made with strong materials

Hut: A very simple shelter made from natural materials.
Kutcha House: A temporary house made with weak materials.
Pucca House: A permanent house made with strong materials

Pincode *

Estimated Loss (₹)

Landmark

Damage Description

Google Map Location

Number of Images Uploaded *

Damage Photo * Only JPG, JPEG, PNG files allowed. Max size: 1MB.

Damage Photo 2 * Only JPG, JPEG, PNG files allowed. Max size: 1MB.

Damage Photo 3 * Only JPG, JPEG, PNG files allowed. Max size: 1MB.

Damage Photo 4 * Only JPG, JPEG, PNG files allowed. Max size: 1MB.

Damage Photo 5 * Only JPG, JPEG, PNG files allowed. Max size: 1MB.

Deceased Member Details

Name of the deceased member *

Applicant Relationship with the deceased member *

Father / Husband Name of deceased *

Number of Family Members *

Gender *

Male

Female

Transgender

Address of deceased *

Married Status *

Married

Unmarried

Burial/Cremation Permit * Only PDF, JPG, JPEG files allowed. Max size: 1MB.

Death Date *

FIR

Age at the time of death *

Death Certificate Only PDF, JPG, JPEG files allowed. Max size: 1MB.

Place of Death *

Medical Certificate Only PDF, JPG, JPEG files allowed. Max size: 1MB.

Cause of death *

Legal Heir Certificate Only PDF, JPG, JPEG files allowed. Max size: 1MB.

Ration Card No. of deceased *

Govt. Issued ID Card of deceased *

Declaration

I Agree *

I declare that above said information is true to the best of my knowledge and belief, I understand that, if any, incorrect information is provided by me, the application is liable to be rejected and appropriate legal action will be taken.

Additional Details

Applied to the Office*

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