11. Power to enhance quantum of grant.

Form X-I
Form X-I
( See Sub-rule (i) of Rule 5)
( See Sub-rule (i) of Rule 5)
Application Form for Rehabilitation Grant to Released Prisoners /Inmates/Probationers.
Application Form for Rehabilitation Grant to Released Prisoners /Inmates/Probationers.
1
Name of the released
prisoners/Inmates/Probationers
: ................................
Photograph of the applicant
2
Age/Date of birth
: ................................
3
Admitted on
: ............... Released
on.....................
4
Father's/ Husband's Name
: ................................
5
Jail Name/Name of institution/probation unit
along with address
: ................................
6
Period of incarceration/ Stay/ Period under
Probation
: ................................
7
Permanent address
: ................................
: ................................
8
Contact No.
: ................................
9
Total income of dependent family member :
10
Particulars of dependent family members :
S.No
S.No
Name
Name
Relationship with the applicant
Relationship with the applicant
Age
Age
Occupation/income
Occupation/income
11
Plan of Livelihood/trade
: ................................
12
Rehabilitation grant applied for
: ................................
13
Details of tools/equipments
: ................................
Column to be filled by jail
superintendent/Supdt./DPO
Column to be filled by jail
superintendent/Supdt./DPO
Period of stay of Prisoner/Inmate/Probationer
Verification of conduct of
Prisoner/Inmate/Probationer :
Signature of Supdt. /In charge
of Jail/Institution/DPO
(Name & Signature of Applicant)
Date: