CABF Web Portal Prototype

Beneficiary Application — Fresh (MFA / One-time Ex-gratia)

Sample form based on CABF structure. All fields are clickable; validations are assumed in backend.

Membership No.

Member Name

Date of Birth

Date of Death

Beneficiary Name

Relationship with Member

Mobile Number

Email ID

Address

Type

Amount Requested (₹)

Bank Account (for NEFT)

IFSC

Bank Name

Upload documents in the prescribed sequence (Death Certificate, ID proofs, Bank details, etc.).

#	Document Name	Required	Status
1	Death Certificate	Yes	Pending
2	Beneficiary ID Proof	Yes	Pending
3	Bank Passbook / Cancelled Cheque	Yes	Pending

I hereby declare that the information provided is true to the best of my knowledge and I agree to the CABF rules.