Financial Aid For Couples Undergoing IVF / ICSI
“The highest form of Knowledge is Empathy.” ~ Bill Bullard
Download the application form - Click here
About the Fund
Medicines up to a maximum MRP of Rs 50,000/- provided (for the course of one complete cycle):
1. Check eligibility – As per the Criteria mentioned above.
2. Download the application form - Click here
3. Submission of Supporting Documents by email to email@example.com -
(a) Filled up Application Form
(b) Proof of Identity and Indian Nationality – PAN Card / Ration Card / Passport / Voter ID / Driving License / any other document approved by the government as valid proof.
(c) Aadhar Card
(d) Marriage Certificate
(e) Last 3 financial years IT Returns; or Bank Statements from all accounts for the last financial year.
4. Reports to be submitted (within last 6 months)–
(a) Wife’s AMH
(b) Wife’s TSH
(c) Husband's semen analysis
5.Scrutiny & verification of data – The Fund Administrators will verify the patient and clinic details submitted as above
6.Case Review by Committee – On successful verification, the case will be presented to the Empathy Fund Committee Members for Approval.
7.Case Approved / Disapproved– On majority vote by the panel
8.Disbursement of Medicines–Once approved, the medicines will be issued directly to the treating centre.
9.Acknowledgement from Doctor – Once the drugs are received, the doctor needs to sign an acknowledgement form confirming receipt of the same.
10. Acknowledgement from Patient – Once the fund is utilised, the reports of the treated patient have to be submitted along with a certificate from the treating Doctor/Centre with the couple’s signatures & Doctor’s stamp on the letterhead confirming that the injections/drugs were utilized for the patient’s treatment.
The decision of approving or rejecting each application will be at the sole discretion of the Empathy Fund Committee Members.