How to claim Grama volunteer PM Garib Kalyan Yojana Scheme

Government of lndia 

గ్రామ వాలంటీర్ అందరికీ ప్రధాన మంత్రి గరిబ్ కళ్యాణ్ యోజన్ పథకం ఎలా పొందాలో ? ఫారం ఎలా నింపలో అనేది ఇక్కడ తెలుసుకోండి


Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi – 110011

AdditionalSecretary & Mission Director (NHM)

D.O. No. F.No. Z-l80l6lll2020lPMGKP-NHM
Dated 03’d
2020

In continuation of letters by Secretary, MoHFW (D.O. No. 2.2102011612020PH, dated 30tr’ March 2020), addressed to all the Chief Secretaries/Administrators of
the States/UTs and the Heads of all the Associations of Doctors lHealthcare providers
regarding ‘Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health
Workers Fighting COVID-I9′, you are requested to kindly inforrn all such health oare
providers through various mediums like SMS, whatsapp, e-rnail etc. in local language
about their inclusion under Pradhan Mantri Garib Kalyan Package : Insurance Scheme
for Health Workers Fighting COVID-19 in line with the enclosed order regarding this
scheme.

The clairn Form-I (Personal Accident Insurance Clairn Form fbr loss of life due
to COVIDl9) and Forrn-II (PersonalAccident Insurance Clairn Form for accidental loss
of life on account of COVID-l9 related duty) for the above scheme detailing the
procedure, claim certiflring authority and documents to be subrnitted along with claim
forrn is also attached for your ref-erence and disbursal.

I request you to give rnore publicity to this initiative to instill a sense of security
alnong healthcare providers. In case of any clarifications, Dr. Manohar Agnani, JS
(RCH) rnay be contacted by the States / UTs at agnanirn@,ias.nic.in.

Yours Sincerely,

1.

Additional Chief Secretary / Principal Secretary

/UTs
2. Mission Directors, National Health Mission,

All

/

Secretary- Health,

States

/ UTs

Tel. : 011-23063693 Telefax : 01{-23061398 E’mall : vandana.g@ias.nic.in

urnani)

All

States

D.O. No. F.No. Z-L80I6[120201PMCKP-NHM

II

:2:
Copy to the following Joint Secretaries to provide necessary instructions to concerned
hospitals / institutions:

1.

2.
3.

4.

JS (Sunil Sharma) – A11 India Institute of Medical Sciences (AIIMS) across
State/s, Post Graduate Institute of Medical Education & Research (PGIMER Chandigarh), Jawaharlal Institute of Post Graduate Medical Education &
Research (JIIPMER, Puducherry), Hospitals or other Medical Colleges under
Pradhan Mantri Swasthya Suraksha Yojna (PMSSY) and any other hospitals
under other ministries.
JS (Alok Saxena) – CGHS (Central Government Health Scheme).
JS (Dr. Nipun Vinayak) – Institutions of Raj Kumari Amrit Kaur College of
Nursing, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram,
Maharashtra, Lady Reading Health School Delhi, Gandhigram Institute of
Rural Health and Family Welfare Trust (GIRHFWT).
JS (Gayatri Mishra) – Hospitals (RML & PGIMER/ Safdarjung Hospitals and
Vardhaman Mahavir Medical College , Lady Hardinge Medical College and
Kalawati Saran Children Hospitals, Chandigarh and other regional institutions.

Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health Workers Fighting COVID-19

FORM-I:
Personal Accident Insurance Claim Form for loss of life due to COVID19

The New India Assurance Company Limited
Regd. & Head Office: New India Assurance Bldg., 87, Mahatma Gandhi Road, Fort, Mumbai – 400 001.

The issuance of this form is not to be taken as an admission of Liability
Personal Accident Insurance Claim Form (Particulars of Accident)
Policy No.
TO BE COMPLETED BY THE CLAIMANT
Name of Insured: Secretary, Ministry of Health and Family Welfare, Govt. of India, New
Delhi

1. Details of Deceased Person who died due to COVID-19

2.

(a)

Full name (Ms./Mr.)________________________________________________

(b)

Father’s name______________________________________________________

(c)

Age at last birthday__________________________________________________

(d)

Sex ______________________________________________________________

(e)

Address___________________________________________________________

(f)

Profession/occupation________________________________________________

(a) Date and Time of Death:

(b) Date of Laboratory diagnosis of
COVID19

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