A&N Islands Building and Other Construction Workers Welfare Board, Port Blair

Pension Financial Assistance

Registration Details of Worker

Registration Number *

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Registration Date *

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Date of Birth *

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Subscription Details of Worker

Latest Subscription Receipt No. *

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Latest Subscription Receipt Date *

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Subscription Paid Upto *

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Personal Details of Worker

Name *

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Category *

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Gender *

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Aadhaar Number *

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Mobile Number *

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E-Mail

Age *

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Address Details of Worker

Address *

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Country *

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State *

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District *

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Tehsil *

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Area/Village/Town

Pin Code *

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Bank Details of Worker

IFSC Code *

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Bank Name *

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Branch Code *

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Branch Name *

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Account Number *

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Required Document to be Uploaded

Life Certificate *

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Date of Issuance *

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Valid Upto *

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Declaration

I hereby declare that the information/ documents provided in above form is true & correct to the best of my knowledge and belief and nothing has been falsely stated. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am liable for action by Competent Authority.

I Agree *