Why This Form Is Important

• It creates a sworn legal record tied to a specific Pension Payment Order, so the deponent's identity and pension status are formally established before any dependant claim is considered.
• It is the formal mechanism for registering legal dependants (name, relationship, age, date of birth, and order/CRD/SD/POR number) so that photographs and details on file match who is actually entitled to ECHS coverage.
• The income declaration (dependant parents' combined monthly income below a stated threshold, and confirmation they are not government/PSU employees or pensioners) is what determines whether parents qualify as dependants at all, making this affidavit a financial-eligibility gatekeeper.
• The son's-age and daughter's-marital/employment-status declarations fix the exact conditions under which children lose ECHS eligibility, so the deponent is on record acknowledging when coverage ends.
• The deponent commits in writing to promptly reporting any change in dependant status (death, marriage, employment) and to refunding treatment costs incurred after a dependant became ineligible, which is what gives ECHS a basis for financial recovery and civil/criminal action if the deponent fails to comply.
• The card-misuse clause puts the deponent on notice that membership can be cancelled without a hearing and that they will bear the cost of any unauthorized use, creating accountability for the physical ECHS card.
• The attestation and witness sections (place, date, identifying witnesses, and a Magistrate/Notary signature) convert the affidavit from a private statement into a document with independent verification, which is what typically gives it standing as legal proof.