Follow the steps to complete the application efficiently.

1. Press the 'Get Form' button to acquire the application form and open it in the editor.
2. Begin by entering the name and age of the patient in the designated fields. Ensure that the details are accurate and up-to-date.
3. Provide the name of the father or partner in the next section. This is an important identifier for the application.
4. Fill in the residential address fully. It is required to attach photocopies of supporting documents, such as the ration card and voter’s identity card for validation.
5. Indicate the name of the disease the patient is suffering from, the duration, and the specific treatment needed.
6. Mention the name of the hospital where the patient is receiving treatment. Be sure to attach a copy of the outpatient department (OPD) slip.
7. State the amount of financial assistance required. An estimate certificate certified by the Head of Department and Medical Superintendent must be attached in original.
8. Provide the monthly income of the family from all sources, duly certified by the area Sub-Divisional Magistrate in original.
9. Attach two passport-sized photographs of the patient. One should be pasted on the estimate certificate, and the other on the application form, both attested by the Medical Superintendent or treating doctor.
10. Answer whether any assistance has been taken from other sources and provide details if applicable.
11. Indicate if any previous assistance from Delhi Arogya Nidhi/Kosh has been received, along with relevant details.
12. Complete the certification section by confirming the information provided is true. Ensure the appropriate person signs the form based on the patient's status: applicant, parent, or partner.
13. Once all information is filled in, review the form for accuracy. Save your changes, and if needed, download, print, or share the completed form.

Complete your Delhi Arogya Kosh Application Form online today to ensure timely financial aid for your medical needs.