Niramaya Card Number (required) Name of the Beneficiary (required) Name of Hitarth Sahayak (required) Year (required) 2024 2025 2026 Period (required) Jan - Mar Apr - Jun Jul - Sep Oct - Dec Claim Report Upload (required) Reimbursement for issuing Niramaya Card (required) Reimbursement above INR 6000 Reimbursement above INR 14,999 Reimbursement above INR 19,999 Reimbursement Amount(required) Check mark all that applies for reimbursement (required) Physiotherapy Speech Therapy OPD (Pathology, diagnostic tests) Dental Preventive Dentistry Medicines Non Surgical / Hospitalization Other Comments I confirm that information submitted is accurate.