PMNRF Assistance Form PDF

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PMNRF Assistance Form

Prime Minister’s National Relief Fund (PMNRF) was established entirely with public contributions and does not get any budgetary support. Prime Minister’s National Relief Fund, (PMNRF) accepts voluntary contributions from Individuals, Organizations, Trusts, Companies, and Institutions, etc. All contributions towards PMNRF are exempt from Income Tax under section 80(G).

Contributions flowing out of budgetary sources of Government or from the balance sheets of the public sector undertakings are not accepted. Conditional contributions, where the donor specifically mentions that the amount is meant for a particular purpose, are not accepted in the Fund.

PMNRF Assistance Form (Necessary Details)

  • Name of the Patient
  • Photograph of Patient
  • Age/Sex of the Patient
  • Father’s /Husband’s name
  • Number of Family members
  • Residential address for correspondence. Please enclosed copy of proof.
  • Contact details of the patient/applicant
  • Telephone/Mobile No.
  • E-mail ID
  • AADHAAR-Card No. (Please enclose self attested copy of the card.)
  • Nature of Disease/ailment/Treatment Required
  • Quantum of Financial Assistance required for future treatment as per estimate given by the hospital.
  • Whether any assistance from PMNRF was received on earlier occasion by the patient.
  • Whether the patient is covered under ‘Ayushman Bharat [Pradhan Mantri Jan Arogya Yojana (PM-JAY)]. If yes, please give Card No. and details of assistance received under ‘Ayushman Bharat [Pradhan Mantri Jan Arogya Yojana (PM-JAY).
  • Whether applied / eligible for any other sources of funding/Assistance from any Govt. agency/NGO/Insurance
    company/Hospital/Employer etc. If Yes, please give details.
  • Whether patient or the person on whom he/she is dependent is an employee of Central Govt./State Govt./Local Bodies/PSU.
  • Occupation and monthly income of the patient or the person on whom he/she is dependent. Please enclose Income
    Certificate issued by District Revenue Authority.
  • Bank Details (Please enclose a copy of passbook first page or cancelled cheque)
  • Bank A/C holder’s Name (Patient/Applicant)
  • Bank Account No.
  • Bank and Branch Name
  • IFSC Code
  • Any Other relevant information.
  • Signature of the patient/applicant

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