ODISHA BUILDING AND OTHER CONSTRUCTION WORKERS' WELFARE BOARD,
BHUBANESWAR.
(FORM XLII)
[See Rule 275(1)]
APPLICATION FOR FINANCIAL ASSISTANCE FOR THE EDUCATION OF CHILDREN OF
THE BENEFICIARY
1. Name of the construction worker : Kailash Muni
2. Gender : Male
3. Marital status : Married
4. Father's name : Ganapati Muni
5. Spouse's name : Tuni Muni
6. Aadhaar Number : 632373571421
7. Name as Per Aadhaar : Kailash Muni
8. Mobile Number : 9937833094
9. Permanent address
(a) Address : Machhakote
(b) District : GANJAM
(c) Block : DHARAKOTE
(d) Village : Machhakote
(e) Gram panchayat : MACHHAKOTE
(f) Pin code :
10. Present Address
(a) Address : Machhakote
(b) District : GANJAM
(c) Block : DHARAKOTE
(d) Village : Machhakote
(e) Gram panchayat : MACHHAKOTE
(f) Pin code : 761106
11. Establishment details
(a) Establishment name where the :
worker is working
(b) Establishment address where the :
worker is working
(b) Establishment registration :
number where the worker is
working
12. Ration card details
(a) Ration card type : Other
(b) NFS / SFS card number :
13. Other details
(a) Category : OBC
(b) Religion : Hindu
(c) Physically Challenged : NO
14. Registration details
(a) Registration number : ODBAM003010945
(b) Date of registration : 23/05/2023
16. Annual Contribution fee
# Receipt no. Annual contribution fee Receipt date Valid from date Valid to date
1 CPACFBEQN4 20.0 11-11-2022 22-05-2023
2 CPAEUIPFS6 50.0 10-02-2025
3 CPADPYUOC3 50.0 15-03-2024 22-05-2024
16. Bank account details
(a) Aadhaar linked bank account : 053910021001489
number
(b) Bank IFSC : UBIN0805394
(c) Name of bank : UNION BANK OF INDIA
(d) Branch of bank : SHERAGADA
17. Details of son (s) / daughter(s) for whom education assistance is sought
Name & Course Name of the Address of the Academic Attendence Amount
DOB School/ Educational School/ Educational Year & Roll details (Rs.)
Institution where Institution where No.
reading reading
Asish Kumar Muni, +3 3RD YEAR Science College ATPO-HINJILICUT, 2024-2025 Total days: 248.0 7000.0
2005-03-12 (Autonomous), Hinjilicut GANJAM, BC22109 Attendence: 198.0
PIN Code: 761106 Percentage: 79.84
18. Benefit availed history
Name & DOB Course Name & Name of the Amount Type Approved details
Academic year Educational (Rs.)
Institution
19. Family details
# Name DOB Aadhaar Relation Data From
1 Tuni Muni 1995-08-15 699069347689 Wife Applicant
2 Asish Kumar Muni 2005-03-12 511083118172 Unmarried son Applicant
3 Bandana Muni 2008-01-17 914115082516 Unmarried daughter Applicant
19. Sanction details
(a) Name : Sri Arun Kumar Khadanga
(b) Designation : HM/Principal
(c) Mobile no. : 9437783219
(d) Date : 12/02/2025
20. WEO sanction details
(a) Name :
(b) Designation :
(c) Mobile no. :
(d) Date :
Declaration by the applicant
I do hereby solemnly declare that the facts mentioned above are true to the best of my knowledge
and belief. In case, any information submitted by me is found wrong, I shall be liable to refund the
same with interest to the board immediately.
Place : GANJAM Signature of the applicant
Date : 14/02/2025
