Section 7(10) in The Rajasthan Rules for Regulating the Fund for Grant of Exgratia Financial Assistance (Family Planning Acceptors) 1976
(10)In case of death-(a)Number of dependent surviving members of the deceased acceptor..............(b)Financial condition of the family........(c)Earning members in the family............I have verified the above facts in respect of Shri/Smt........ and recommend financial assistance of Rs............. towards the expenditure incurred by him/her in connection with the treatment of complications caused on account of Sterilisation/IUD insertion. The medicines purchased were essential for the recovery of the acceptor. These Medicines were not available in the............... Hospital for supply to the patient and do not include tonics, toilets, disinfectants, food etc.It is certified that the applicant or her husband/wife is not a Government servant and he is not entitled to get the expenses claimed above reimbursed through any other sources.Signature of the Medical OfficerIncharge of the case with seal.Signature of the applicant withfather/husbands name and full address.Signature of the Medical Officer Inchargeof the Hospital or Superintendent of theHospital in case of death case.CountersignedD. Chief Medical and Health Officer,(FP)District.............Rajasthan.
