I
[See rules 56 (a), 71 (a) and 72 (a) (ii)]MANNER OF TEST AND EXAMINATION BEFORE TAKING LIFTING APPLIANCE, LOOSE GEAR AND WIRE ROPE INTO USE FOR THE FIRST TIMETest Loads:(1)Lifting Appliance. - Every lifting appliance with its accessory gear, shall be subjected to a test load which shall exceed the safe working load (SWL) as specified in the following table: -TABLE
| Safe working load Test load |
Test load |
| Up to 20 tonnes |
25 per cent. in excess of safe working load |
| 20 to 50 tonnes |
5 tonnes in excess of safe working load |
| Over 50 tonnes |
10 per cent. in excess of safe working load |
(2)Loose Gear. - (a) Every ring, hook, chain, shackle, swivel, eye-bolt, plate clamp, triangular plate or pulley block (except single sheave block) shall be subjected to a test load which shall not be less than the load as specified in the following table: -TABLE
| SWL (in tonnes) |
Test load (in tonnes) |
| Up to 25 |
2 x safe working load |
| Above 25 |
(1.22 x safe working load) + 20 |
(b)In the case of a single sheave block, the safe working load shall be the maximum load which can safely be lifted by the block when suspended by its head fitting and the load is attached to a rope which passes around the sheave of the block and a test load not less than four times the proposed safe working load shall be applied to the head of the block.(c)In the case of a multi sheave block, the test load shall not be less than the load as specified in the following table: -TABLE
| SWL (in tonnes) |
Test load (in tonnes) |
| Up to 25 |
2 x safe working load |
| 25 to 160 |
(0.9933 x safe working load)+ 27 |
| Above 160 |
1.1 x safe working load |
(d)In the case of hand-operated pulley blocks used with pitched chains and rings, hooks, shackles or swivels, permanently attached thereto, a test load not less than 50 per cent. in excess of the safe working load shall be applied.(e)In the case of a pulley block fitted with a bucket, the bucket shall be tested and the load applied to the bucket when testing that block will be accepted as test load of the bucket.(f)In the case of a sling having two legs, the safe working load shall be calculated when the angle between the legs is 90 degree. In case of multi-legged slings the safe working load shall be calculated as per national standards.(g)Every lifting beam, lifting frame, container spreader, bucket, tub, or other similar devices shall be subjected to a test load which shall not be less than the load as specified in the following table: -TABLE
|
Proposed safe working load (intonnes)
|
Test load (in tonnes) |
| Up to 10 |
2 x safe working load |
| 10 to 160 |
(1.04 x safe working load)+ 9.6 |
| Above 160 |
1.1 x safe working load |
(h)Wire ropes. - In the case of wire ropes a sample shall be tested to destruction. The test procedure shall be in accordance with recognised national standards. The safe working load of the rope is to be determined by dividing the load at which the sample broke by a co-efficient of utilisation, determined as specified in the following table: -TABLE
| |
Item |
Co-efficient of utilisation |
| (a) |
Wire Rope forming part of Sling. Safe working load of theSling: Safe working load up to and equal to 10 tonnes. SWL above10 tonnes and up and equal to 160 tonnes.
|
510________________(8.85 x SWL) +1910
|
| |
Safe working load above 160 tonnes. |
3 |
| (b) |
Wire Rope as Integral part of a Lifting Appliance: SWL of thelifting appliance: SWL up to and equal to 160 tonnes.
|
10________________(8.85 x SWL)+ 1910 |
| |
SWL above 160 tonnes. |
3 |
(i)Before any test is carried out, a visual inspection of the lifting appliance, or lifting gear involved shall be conducted and any visible defective gear shall be replaced or renewed.(j)After being tested, all the lifting gears shall be examined to see whether any parts have been injured or permanently deformed by the test.Procedure for testing:(3)Derricks. - (a) A derrick shall be tested with its boom at the minimum angle to the horizontal for which the derrick is designed (generally 15 degrees) or at such greater angle as may be agreed. The angle at which the test has been carried out shall be mentioned in the test certificate. The test load shall be applied by hoisting moveable weights. During the test, the boom shall be swung with the test load, as far as practicable, in both directions.(b)A derrick boom, designed to be raised with power, with the load suspended, shall, in addition to the tests at (a), be raised (with the load suspended) to its maximum working angle to the horizontal and the two outermost positions.(c)While test loading of a heavy lift derrick, the competent person responsible for tests using moveable weights, shall ascertain from the Master that the ship's stability will be adequate for the test.(4)The derricks tested under clause (3) shall not be used in union purchase rig unless:(a)the derricks rigged in union purchase are tested with the test load appropriate to the SWL in union purchase (at the designed headroom and with the derrick booms in their approved working positions);(b)the safe working load of that derrick in union purchase rig has also been specified by a competent person in a report in Form V;(c)any limitation or conditions specified in the said report are complied with; and(d)the two hoist ropes are coupled together by a suitable swivel assembly.Note. - The safe working loads of derricks (for each method of rig including union purchase) shall be shown on the Certificate of Test and marked on the derrick booms.(5)Lifting appliances (other than ship's derricks and winches). - (a) The test load shall be lifted and swung, as far as possible, in both directions. If the jib or boom of the crane has a variable radius, it shall be tested with test loads at the maximum and minimum radii. In case of hydraulic cranes when owing to the limitation of pressure, it is impossible to lift a test load in accordance with table under item (1), it will be sufficient to lift the greatest possible load which shall be more than safe working load.(b)The test shall be performed at maximum, minimum and intermediate radius points as well as such points in the arc of rotation, as the competent person may decide. The test shall consist of hoisting, lowering, breaking and swinging through all positions and operations normally performed. An additional test shall be made by operating the machinery at maximum working speed with the safe working load suspended.(6)Use of spring or hydraulic balances, etc. for test loading. - All tests shall normally be carried on with the help of dead weights. In case of periodical test, replacements or renewals, test load may be applied by means of suitable springs or hydraulic balances. In such case, test load shall be applied with the boom, as far out as practicable, in both directions. The test shall not be taken as satisfactory unless the balance has been certified for accuracy by the competent authority within 2.0 per cent and the pointer of the machine has remained constant at the test load for a period of at least five minutes.(7)Testing machines and dead weights. - (a) A suitable testing machine shall be used for testing of chains, wire ropes and other lifting gears.(b)Testing machines and balances to be used in test loading, testing and checking shall not be used unless they have been certified for accuracy at least once in the preceding twelve months by the competent authority.(c)Movable weights used for the test loading of the lifting appliances having a safe working load not exceeding twenty tonnes shall be checked for accuracy by means of suitable weighing machine of certified accuracy.(8)Thorough examination after testing or test loading. - After being tested or test loaded, every lifting appliance and associated gear shall be thoroughly examined to see that no part has been damaged or permanently deformed during the test. For this purpose, the lifting appliance or gear shall be dismantled to the extent considered necessary by the competent person.
II
NOTIFIABLE OCCUPATIONAL DISEASES IN BUILDING AND OTHER CONSTRUCTION WORK[See rule 230 (a)]1. Occupational dermatitis.
5. Lead poisoning including poisoning by any preparation or compound of lead or their sequelae.
6. Benzene poisoning, including poisoning by any of its homologues, their nitro or amido derivatives or its sequelae.
9. Carbon monoxide poisoning.
12. Compressed air illness (Caissions disease).
13. Noise induced hearing loss.
14. Isocyanates poisoning.
III
CONTENTS OF A FIRST-AID BOX[See rule 231 (b)](i)A sufficient number of eye wash bottles filled with distilled water or suitable liquid clearly indicated by a distinctive sign which shall be visible at all times.(ii)4 per cent. xylocaine eye drops, and boric acid eye drops and soda bycarbonate eye drops.(iii)Twenty-four small sterilised dressings.(iv)Twelve-medium size sterilised dressings.(v)Twelve large size sterilised dressing.(vi)Twelve large size sterilised burn dressings.(vii)Twelve (fifteen cm) packets of sterilised cotton wool.(viii)(Two hundred ml) bottle of cetrimide solution (1 per cent.) or suitable antiseptic solution.(ix)One (two hundred ml) bottle of mercurochrome (2 per cent.) solution in water.(x)One (one hundred twenty ml) bottle of salvolatile having the doses and mode of administration indicated on the label.(xi)One pair of scissors.(xii)One roll of adhesive plaster (six cm x one metre).(xiii)Two rolls of adhesive plaster (two cms x one metre).(xiv)Twelve pieces of sterilised eye pads in separate sealed packets.(xv)A bottle containing hundred tablets (each of three hundred twenty-five mg) of aspirin or any other analgesic.(xvi)Twelve roller bandages ten cms wide.(xvii)Twelve roller bandages five cms wide.(xix)A supply of suitable splints.(xx)Three packets of safety pins.(xxii)A snake bite lancet.(xxiii)One (thirty ml) bottle containing potassium permanganate crystals.(xxiv)One copy of first-aid leaflet issued by the Directorate General.(xxv)Six triangular bandages.(xxvi)Two pairs of suitable, sterilised, latex hand gloves.
IV
[See rule 226 (c)]ARTICLES FOR AMBULANCE ROOM(i)A glazed sink with hot and cold water always available.(ii)A table with a smooth top at least 180 cm x 105 cm.(iii)Means for sterilising instruments.(vi)Two buckets or containers with close fitting lids.(vii)Two rubber hot water bags.(viii)A kettle and spirit stove or other suitable means of boiling water.(ix)Twelve plain wooden splints 900 cm x 100 cm x 6cm.(x)Twelve plain wooden splints 350 cm x 75 cm x 6 cm.(xi)Six plain wooden splints 250 cm x 50 cm x 12 cm.(xii)Six woollen blankets.(xiii)Three pairs of artery forceps.(xiv)One bottle of spiritus anemiae aremations (120 ml).(xv)Smelling salt (60 gm).(xvi)Two medium size sponges.(xviii)Four kidney trays.(xix)Four cakes of toilet, preferably antiseptic soap.(xx)Two glass tumblers and two wine glasses.(xxi)Two clinical thermometers.(xxiii)Two graduated (120 ml.) measuring glasses.(xxiv)Two minimum measuring glasses.(xxv)One wash bottle (1000 cc) for washing eyes.(xxvi)One bottle (one litre) carbolic lotion 1 in 20.(xxix)One electric hand torch.(xxx)Four first-aid boxes or cupboards stocked to the standards prescribed in the Schedule VII.(xxxi)An adequate supply of tetanus toxide.(xxxii)Injections - morphia, pethidine, atrophine, adrenaline, coramine, novocaine (6 each).(xxxiii)Cramine liquid (60 ml.).(xxxiv)Tablets - antihistaminic antispasmodic (25 each).(xxxv)Syringes with needles - 2 cc, 5 cc, 10 cc and 500 cc.(xxxvi)Three surgical scissors.(xxxvii)Two needle holders, big and small.(xxxviii)Suturing needles and materials.(xxxix)Three dissecting forceps.(xl)Three dressing forceps.(xlii)One stethoscope and a B.P. apparatus.(xliii)Rubber bandage - pressure bandage.(xliv)Oxygen cylinder with necessary attachments.(xlv)Atropine eye ointments.(xlvi)I.V. Fluids and sets 10 nos.(xlvii)Suitable, foot operated, covered, refuse containers.(xlviii)Adequate number of sterilised, paired, latex hand gloves.
V
(See rule 227)CONTENTS OF AMBULANCE VAN OR CARRIAGEThe ambulance van shall have equipments prescribed as under:(a)General. - A portable stretcher with folding and adjusting devices with the Head of the stretcher capable of being tilted upward. Fixed suction unit with equipment. Fixed oxygen supply with equipment. Pillow with case, sheets, blankets, towels, emergency bag, bed pan, urinal glass.(b)Safety Equipment. - Flaros with life of three thousand minutes, floor lights, flash lights, fire extinguishers (dry powder type), insulated gantlets.(c)Emergency Care Equipment. - (i) Resuscitation. - Portable suction unit, portable oxygen unit, bagvalve mask, hand operated artificial ventilation unit, airways, mouthgag tracheotomy adapters, short spine board, I.V. FLUIDS with administration unit, B.P. manometer cuff stethoscope.(ii)Immobilisation. - Long and short padded boards, wire ladder splints, triangular bandage-long and short spine boards.(iii)Dressing. - Gauze pads-100 m x.400 mm universal dressing 250 x 1000 mm, roll of aluminium foils-soft roller bandages 150 mm x 5 mm yards adhesive tape in 75 mm roll safety pins, bandage sheets, burn sheets.(iv)Poisoning. - Syrup of Ipecac, activated charcoal prepacketed dose, snake bite kit, drinking water.(v)Emergency Medicines. - As per requirement (under the advice of construction Medical Officer).
VI
PERMISSIBLE EXPOSURE IN CASES OF CONTINUOUS NOISE(See rule 34)
|
Total time of exposure (continuous or a number of short-termexposures) per day (in hours)
|
Second pressure level (in dBA) |
| (1) |
(2) |
| 8 |
90 |
| 6 |
92 |
| 4 |
95 |
| 3 |
97 |
| 2 |
100 |
| 1½ |
102 |
| 1 |
105 |
| ¾ |
107 |
| ½ |
110 |
| ¼ |
115 |
Notes. - 1. No exposure in excess of 115 dBA is to be permitted.2. For any period of exposure falling in between any figure and the next higher or lower figure as indicated in column (1), the permissible sound pressure level is to be determined by extrapolation on a proportionate basis.
VII
PERIODICITY OF MEDICAL EXAMINATION OF BUILDING WORKERS[See rules 81 (iv) and 223 (a) (iii)]1. The employer shall arrange a medical examination of all the building workers employed as drivers, operators of lifting appliances and transport equipment before employing, after illness or injury, if it appears that the illness or injury might have affected his fitness and, thereafter, once in every two years up to the age of forty and once in a year, thereafter.
2. Complete and confidential records of medical examination shall be maintained by the employer or the physician authorised by the employer.
3. The medical examination shall include -
(a)full medical and occupational history.(b)clinical examination with particular reference to -(ii)Vision. - Total visual performance using standard orthorator like Titmus Vision Tester should be estimated and suitability ascertained for placement in accordance with the prescribed job standards.(iii)Hearing. - -Persons with normal hearing must be able to hear a forced whisper at twenty-four feet. Person using hearing aids must be able to hear a warning shout under noisy working conditions.(iv)Breathing. - Peak flow rate using standard peak flow meter and the average peak flow rate determined out of these readings of the test performed. The results recorded at pre-placement medical examination could be used as a standard for the same individual at the same altitude for reference during subsequent examination.(v)Upper Limbs. - Adequate arm function and grip (both arms).(vi)Lower Limbs. - Adequate leg and foot function.(vii)Spine. - Adequately flexible for the job concerned.(viii)General. - Mental alertness and stability with good eye, hand and foot coordination.(c)Any other tests which the examining doctor considers necessary.
VIII
[See rules 209 (1) and (2)]NUMBER OF SAFETY OFFICERS, QUALIFICATION, DUTIES, ETC.Appointment of Safety OfficersNumber of Safety Officers. - Within six months of coming into operation of these rules, every establishment employing more than five hundred building workers and every other employer of building worker shall appoint safety officers, as laid down in the scale given below: -1. Up to 1000 building workers---one safety officer.
2. Up to 2000 building workers---two safety officers.
3. Up to 5000 building workers---three safety officers.
4. Up to 10,000 building workers---four safety officers.
For every additional 5000 building workers or part thereof-one safety officer.Any appointment, when made shall be notified to the inspector having jurisdiction in the area, giving full details of the qualifications, terms and conditions of service of such safety officer.Qualification. - (a) A person shall not be eligible for appointment as a safety officer unless he -(i)possesses a recognised degree in any branch of engineering or technology or architecture and had a practical experience of working in a building or other construction work in a supervisory capacity for a period of not less than two years or possesses a recognised diploma in any branch of engineering or technology and has had practical experience of building or other construction work in a supervisory capacity for a period of not less than five years;(ii)possesses a recognised degree or diploma in industrial safety with at least one paper in construction safety (as an elective subject);(iii)has adequate knowledge of the language spoken by majority of building workers from the construction site in which he is to be appointed.(b)Notwithstanding the provision contained in clause (a), any person who -(i)possesses a recognised degree or diploma in engineering or technology or architecture and has had experience of not less than five years in the field, dealing with the administration of Factories Act, 1948 or the Dock Workers (Safety, Health and Welfare) Act, 1986 or the Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996;(ii)possesses a recognised degree or diploma in engineering or technology and has had experience of not less than five years or has undergone training in education, consultancy or research in the field or accident prevention in industry, port, or in any institution or an establishment dealing with building or other construction work, shall also be eligible for appointment as a safety officer:Provided that, in case of person who has been working as safety officer in industry or port, institution or an establishment dealing with building or other construction work for a period of not less than three years on the date of commencement of these rules, the Chief Inspector of Inspections of Building and Construction may, subject to such conditions that he may specify, relax all or any of the above said qualification.Condition of Service. - (a) Where number of safety officers appointed exceeds one, one of them shall be designated as Chief Safety Officer and shall have the status higher than the others. The Chief Safety Officer shall be in over all charge of the safety functions as envisaged in sub-clause (iv) and also other safety officers working under his control.(b)The Chief Safety Officer or Safety Officer, where only one safety officer is appointed, shall be given the status of a Senior Executive and he shall work directly under the control of his Chief Executive. All other safety officers shall be given appropriate status to enable them to dispatch their functions effectively.(c)the scale of pay and allowances to be granted to the safety officers including the Chief Safety Officer and the other conditions of their service shall be the same as those of the officers of corresponding status of the establishment in which they are employed.Duties of Safety Officer. - (a) The duties of a Safety Officer shall be to advise and assist the employer in the fulfilment of his obligations, statutory or otherwise concerning prevention of personal injuries and maintaining a safe working environment. These duties shall include the following, namely: -(i)to advise the building workers in planning and organising measures necessary for effective control of personal injuries;(ii)to advise on safety aspects in a building or other construction work and to carry out detailed safety studies of selected activities;(iii)to check and evaluate the effectiveness of action taken or proposed to be taken to prevent personal injuries;(iv)to advise purchasing and ensuring quality of personal protective equipment confirming to national standards;(v)to carry out safety inspections of building or other construction work in order to observe the physical conditions of work and the work practices and procedures followed by building workers and to render advice on measures to be adopted for removing unsafe physical conditions and preventing unsafe actions by building workers;(vi)to investigate all fatal and other selected accidents;(vii)to investigate the cases of occupational diseases contracted and reportable dangerous occurrences;(viii)to advise on the maintenance of such records as are necessary with regard to accidents, dangerous occurrences and occupational diseases;(ix)to promote the working of safety committees and to act as an advisor to such committees;(x)to organise, in association with concerned departments, campaigns, competitions, contests and other activities which will develop and maintain the interest of building workers in establishing and maintaining safe conditions of work and procedures;(xi)to design and conduct, either independently or in collaboration with other agencies, suitable training and educational programmes for prevention of accidents to building workers;(xii)to frame safe rules and safe working practices in consultation with senior officials of the establishment;(xiii)supervise and guide safety precautions to be taken in ports, building and other construction work of the establishment.Facilities to be provided to safety officers. - The employer shall provide each safety officer with such facilities, equipment and information that are necessary to enable him to dispatch his duties effectively.Prohibition of performance of other duties. - No Safety Officer shall be required or permitted to do any work which is unconnected to, inconsistent with or detrimental to the performance of the duties prescribed in this Schedule.Exemptions. - Director General may, in writing, exempt any employer or group of employers from any or all of the provisions of these rules subject to compliance with such alternative arrangements as may be approved and notified by him in the order or such exemption.
IX
(See rule 225)Hazardous process:(3)Work under and over water.(5)Work in confined spaces.
X
[See rule 225 (b)]Services and facilities to be provided in occupational health centres. - (1) One full time construction medical officer for building or other construction work, employing workers up to one thousand and one additional construction medical officer for every additional one thousand workers or part thereof.(2)The staff, including one nurse, one dresser-cum-compounder, one sweeper-cum-ward boy with each construction medical officer for full work hours.(3)The occupational health centre with a floor area of minimum fifteen square metres constituting two rooms with smooth walls and impovious service, adequately illuminated and ventilated.(4)Adequate equipment for day-to-day treatment.(5)Necessary equipment to manage any medical emergency.
XI
[See rules 119 (2) and 225 (c)]Qualification of construction medical officer. - (1) MBBS degree from a medical institute recognised by the Medical Council of India; and(2)Diploma in industrial health or equivalent post-graduate certificate of training in industrial health or health.(3)A medical officer having working experience in organisation/establishments involved in policy, execution and advice and safety and health of workers employed in mines, ports and docks, factories and building and other construction work, for a period of not less than three years may, subject to the satisfaction of the Chief Inspector of Inspections of Building and Construction, may not be required to possessing the training referred to in item (2) above.(4)The syllabi of the courses leading to the above certificates and the organisation conducting such courses shall be approved by the Government of National Capital Territory of Delhi who may also from time to time prepare a panel of such organisations.(5)Complete particulars including name, qualification and experience of the construction medical officer will be intimated to the inspector having jurisdiction.
XII
[See rule 152 (a)]PERMISSIBLE LEVELS OF CERTAIN CHEMICAL SUBSTANCES IN THE WORK ENVIRONMENT
| Sl. No |
Substance |
Permissible limit of exposure |
|
Time-weighted average concentraction (TWA) (8hrs.)
|
Short-term exposure limit (STEL) (15 min.)* |
| ppm |
mg./m |
ppm |
mg./m |
| 1 |
2 |
3 |
4 |
5 |
6 |
| 1. |
Acetaldehyde |
100 |
180 |
150 |
270 |
| 2. |
Acetic acid |
10 |
25 |
15 |
37 |
| 3. |
Acetone |
750 |
1780 |
1000 |
2375 |
| 4. |
Aerolein |
0.1 |
0.25 |
0.3 |
0/8 |
| 5. |
Acrylonitrile-Skin (S.C.) |
2 |
4.5 |
- |
- |
| 6. |
Aldrin-Skin |
- |
0.25 |
- |
- |
| 7. |
Allyl chloride |
1 |
3 |
2 |
6 |
| 8. |
Ammonia |
25 |
18 |
35 |
27 |
| 9. |
Aniline-Skin |
2 |
10 |
- |
- |
| 10. |
Anisidine (O-,p-isomers)-Skin |
0.1 |
0.5 |
- |
- |
| 11. |
Arsenic & soluble compounds (as As) |
- |
0.2 |
- |
- |
| 12. |
Benzene (S.C.) |
10 |
30 |
- |
- |
| 13. |
Beryllium & Compound (As Be) (S.C.) |
- |
0.002 |
- |
- |
| 14. |
Boron trifluoride-C |
1 |
3 |
- |
- |
| 15. |
Bromine |
0.1 |
0.7 |
0.3 |
2 |
| 16. |
Butane |
800 |
1900 |
- |
- |
| 17. |
2-Butanone (Methyl ethyl Ketone-MBK) |
200 |
590 |
300 |
885 |
| 18. |
n-Butyl acetate |
150 |
710 |
200 |
950 |
| 19. |
n-Butyl alcohol-Skin-C |
50 |
150 |
- |
- |
| 20. |
Sec/tart. Butyl acetate |
200 |
950 |
- |
- |
| 21. |
Butyl mercaptan |
0.5 |
1.5 |
- |
- |
| 22. |
Cadmium Dust and salts (as Cd) |
- |
0.05 |
- |
- |
| 23. |
Calcium oxide |
- |
2 |
- |
- |
| 24. |
Carbaryl (Sevin) |
- |
5 |
- |
- |
| 25. |
Carbofuran (Furadan) |
- |
0.1 |
- |
- |
| 26. |
Carbon disulphide-Skin |
10 |
30 |
- |
- |
| 27. |
Carbon monoxide |
50 |
55 |
400 |
440 |
| 28. |
Carbon tetrachloride-Skin (S.C.) |
5 |
30 |
- |
- |
| 29. |
Chlordane-Skin |
- |
0.5 |
- |
- |
| 30. |
Chlorine |
1 |
3 |
3 |
9 |
| 31. |
Chlorobenzene (monochlorobenzene) |
75 |
350 |
- |
- |
| 32. |
Chloroform (S.C.) |
10 |
50 |
- |
- |
| 33. |
bis (Chloromethy) ether (H.C.) |
0.001 |
0.005 |
- |
- |
| 34. |
Chromie acid and chromates (as Cr.) (water soluble) |
- |
0.05 |
- |
- |
| 35. |
Chromous salts (as Cr.) |
- |
0.5 |
- |
- |
| 36. |
Copper fume |
- |
0.2 |
- |
- |
| 37. |
Cotton dust, raw |
- |
0.2* |
- |
- |
| 38. |
Cresol, all isomers-Skin |
5 |
22 |
- |
- |
| 39. |
Cyanides (as CN)-Skin |
- |
1 |
- |
- |
| 40. |
Cyanogens |
10 |
20 |
- |
- |
| 41. |
DDT (Dishlorodiphenyl trichloroethane) |
- |
1 |
- |
- |
| 42. |
Demeton-Skin |
0.01 |
0.1 |
- |
- |
| 43. |
Diazinon-Skin |
- |
0.1 |
- |
- |
| 44. |
Dibutyl phthalate |
- |
5 |
- |
- |
| 45. |
Dichlorvos (DDVP) - Skin |
0.1 |
1 |
- |
- |
| 46. |
Dieldrin-Skin |
- |
0.25 |
- |
- |
| 47. |
Dinitrobenzene (all isomers)-Skin |
0.15 |
1 |
- |
- |
| 48. |
Dinitrotoluene-Skin |
- |
1.5 |
- |
- |
| 49. |
Diphenyl (Biphenyl) |
0.2 |
1.5 |
- |
- |
| 50. |
Endosulfan (Thiodan)-Skin |
- |
0.1 |
- |
- |
| 51. |
Endrin-Skin |
- |
0.1 |
- |
- |
| 52. |
Ethyl acetate |
400 |
1400 |
- |
- |
| 53. |
Ethyl alcohol |
1000 |
1900 |
- |
- |
| 54. |
Ethylamine |
10 |
18 |
- |
- |
| 55. |
Fluorides (as F) |
- |
2.5 |
- |
- |
| 56. |
Fluorine |
1 |
2 |
2 |
4 |
| 57. |
Formaldehyde (S.C.) |
1.0 |
1.5 |
2 |
3 |
| 58. |
Formic acid |
5 |
9 |
- |
- |
| 59. |
Gasoline |
300 |
900 |
500 |
1500 |
| 60. |
Hydrazine-Skin (S.C.) |
0.1 |
0.1 |
- |
- |
| 61. |
Hydrogen chloride-C |
5 |
7 |
- |
- |
| 62. |
Hydrogen cyanide-Skin-C |
10 |
10 |
- |
- |
| 63. |
Hydrogen fluorine (as F)-C |
3 |
2.5 |
- |
- |
| 64. |
Hydrogen peroxide |
1 |
1.5 |
- |
- |
| 65. |
Hydrogen sulphide |
10 |
14 |
15 |
21 |
| 66. |
Iodine-C |
0.1 |
1 |
- |
- |
| 67. |
Iron Oxide Fume (Fe 0) (as Fe) |
- |
5 |
- |
- |
| 68. |
Isoamyl acetate |
100 |
525 |
- |
- |
| 69. |
Isoamyl alcohol |
100 |
360 |
125 |
450 |
| 70. |
Isobutyl alcohol |
50 |
150 |
- |
- |
| 71. |
Lead, inorg., dusts and fumes (as Pb) |
- |
0.15 |
- |
- |
| 72. |
Lindane-Skin |
- |
0.5 |
- |
- |
| 73. |
Malathion-Skin |
- |
10 |
- |
- |
| 74. |
Manganese dust and compounds (as Mn)-C |
- |
5 |
- |
- |
| 75. |
Manganese fume (as Mn) |
- |
1 |
- |
- |
| 76. |
Mercury (as Hg)-Skin |
|
|
|
|
| |
(i) Alkyl compounds |
- |
0.01 |
- |
0.03 |
| |
(ii) All forms except alkyl vapour |
- |
0.05 |
- |
- |
| |
(iii) Aryl and inorganic compounds |
- |
0.1 |
- |
- |
| 77. |
Methyl alcohol (Methanol)-Skin |
200 |
260 |
250 |
310 |
| 78. |
Methyl collosolve (2-Methoxy-ethanol)-Skin |
5 |
16 |
- |
- |
| 79. |
Methyl isobutyl ketone |
50 |
205 |
75 |
300 |
| 80. |
Methyl isocyanate-Skin |
0.02 |
0.05 |
- |
- |
| 81. |
Naphthalene |
10 |
50 |
15 |
75 |
| 82. |
Nickel carbonyl (as Ni) |
0.05 |
0.35 |
- |
- |
| 83. |
Nitric acid |
2 |
5 |
4 |
10 |
| 84. |
Nitric oxide |
25 |
30 |
- |
- |
| 85. |
Nitrobenzene-Skin |
1 |
5 |
- |
- |
| 86. |
Nitrogen dioxide |
3 |
6 |
5 |
10 |
| 87. |
Oil mist, mineral |
- |
5 |
- |
10 |
| 88. |
Ozone |
0.1 |
0.2 |
0.3 |
0.6 |
| 89. |
Parathion-Skin |
- |
0.1 |
- |
- |
| 90. |
Phenol-Skin 5 |
19 |
- |
- |
|
| 91. |
Phorate (Thimet)-Skin |
- |
0.05 |
- |
0.2 |
| 92. |
Phosgene (Carbonyl chloride) |
0.1 |
0.4 |
- |
- |
| 93. |
Phosphine |
0.3 |
0.4 |
1 |
1 |
| 94. |
Phosphoric acid |
- |
1 |
- |
3 |
| 95. |
Phosphorus (yellow) |
- |
0.1 |
- |
- |
| 96. |
Phosphorus pentachloride |
0.1 |
1 |
- |
- |
| 97. |
Phosphorus trichloride |
0.2 |
1.5 |
0.5 |
3 |
| 98. |
Pierie acid-Skin |
- |
0.1 |
- |
0.3 |
| 99. |
Pyridine |
5 |
15 |
- |
- |
| 100. |
Silane (Silicon tetrahudride) |
5 |
7 |
- |
- |
| 101. |
Sodium hydroxide-C |
- |
2 |
- |
- |
| 102. |
Styrene, monomer (Phenylethylene) |
50 |
215 |
100 |
425 |
| 103. |
Sulphur dioxide |
2 |
5 |
5 |
10 |
| 104. |
Sulphur hexafluoride |
1000 |
6000 |
- |
- |
| 105. |
Sulphuric acid |
- |
1 |
- |
- |
| 106. |
Tetraethyl lead (as Pb)-Skin |
- |
0.1 |
- |
- |
| 107. |
Tolune (Toluol) |
100 |
375 |
150 |
560 |
| 108. |
O-Toluidine-Skin (S.C.) |
2 |
9 |
- |
- |
| 109. |
Tributvi phosphate |
0.2 |
2.5 |
- |
- |
| 110. |
Trichloroethylene |
50 |
270 |
200 |
1080 |
| 111. |
Uranium, natural (as U) |
- |
0.2 |
- |
0.6 |
| 112. |
Vinyl chloride (H.C.) |
5 |
10 |
- |
- |
| 113. |
Welding fumes |
- |
5 |
- |
- |
| 114. |
Xylene (O-,m-, p-isomers) |
100 |
435 |
150 |
655 |
| 115. |
Zinc oxide |
|
|
|
|
| |
(i) Fume |
- |
5.0 |
- |
10 |
| |
(ii) Dust (Total dust) |
- |
10.0 |
- |
- |
| 116. |
Ziroconium compounds (as Zr) |
- |
5 |
- |
10 |
ppm___ Parts of vapour or gas per million parts of contaminated air by volume at 25C and 760 mm of Hg.mg/m___ milligram of substance per cubic metre of air.*Not more than 4 times a day with at least 60 min. interval between successive exposures.
| ** mg/m = |
Molecular weight___________________________ |
x ppm |
| 24.45 |
G_____denotes Ceiling Limit.Skin._____denotes potential contribution to the overall exposure by the coetaneous route including mucous membranes and eye.S.C._____denotes Suspected Human Carcinogen.H.C._____denotes Confirmed Human Carcinogen.
| Substance |
Permissible time-weighted average concentration (TWA) (8Hrs.)
|
|
Silica, SiO(a) Crystalline(i) Quartz10600(1) In termsof dust count------------------------------- mppem% Quartz = 1010(2) In termsof respirable dust-------------------------------- mg/m³% respirable Quartz + 230(3) In termsof total dust--------------------------------- mg/m³% Quartz + 3
|
|
(ii) Cristobalite(iii) Tridvmite(iv) Silica, fused(v) Tripoli(b) Amorphous SilicatesAsbestos(h.C.)Portland CementCoal Dust
|
Half the limits given againstquartz.Half the limits given againstquartz.Same limits as for quartz.Same limits as in formula in item(2) given against quartz.10mg/m³,Total dust.*2 fibres/ml, greater than 5 m inlength and less than 3 m in breadth with length to breadth ratioequal to or greater than 3:1.10mg/m³,Total dust containing less than 1% quartz.2mg/m³,respirable dust fraction containing less than 5% quartz.
|
|
mppcm**
|
Million particles per cubic metreof air, based on impinger samples counted by light-fieldtechniques.As determined by the membranefilter method at 400-450 x magnification (4 mm objective) phasecontrast illumination.Respirable Dust:Fraction passing a size-selector with the followingcharacteristics:
|
|
AerodynamicDiameter (m) (unit density sphere)
|
% passing selector |
| < 2 |
90 |
| 2.5 |
75 |
| 3.5 |
50 |
| 5.0 |
25 |
| 10 |
00 |
FORM ITHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rule 23 (1)]APPLICATION FOR REGISTRATION OF ESTABLISHMENTS EMPLOYING BUILDING WORKERS1. Name and location of the Establishment where building or other construction work is to be carried on.
2. Postal address of the Establishment.
3. Full name and permanent address of the Establishment, if any.
4. Full name and address of the Manager or person responsible for the supervision and control of the Establishment.
5. Nature of building or other construction work carried/is to be carried on in the Establishment.
6. Maximum number of building workers to be employed on any day.
7. Estimated date of commencement of building or the other construction work.
8. Estimated date of completion of the building or other construction work.
9. Particulars of demand draft, enclosed (name of the Bank, amount, demand draft No. and date).
Declaration by the employer(i)I hereby declare that the particulars given above are true to the best of my knowledge and belief.(ii)I undertake to abide by the provisions of the Building and other Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996 and the rules made thereunder.Principal EmployerSeal and Stamp(For office use)Office of the Registering Officer appointed under the Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996 and Central Rules made thereunder.Date of Receipt of application:FORM IITHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rule 24 (1)]No. Date:GOVERNMENT OF NATIONAL CAPITAL TERRITORY OF DELHI OFFICE OF THE REGISTERING OFFICERA Certificate of Registration is hereby granted under sub-section (3) of section of the Building and other Construction Workers (Regulation of Employment and :onditions of Service) Act, 1996 and the rules made thereunder, to 4/s .................................... having the following particulars subject to conditions laid town in the Annexure:1. Postal Address/location where building or other construction work is to be carried on by the Employer.
2. Name and address of employer including location of the building and other construction work.
3. Name and permanent address of the establishment.
4. Nature of work in which building workers are employed or are to be employed.
5. Maximum number of building workers to be employed on any day by the employer.
6. Probable date of commencement and completion of work.
7. Other particulars relevant to the employment of building workers.
Signature of Registering Officer with SealANNEXUREThe registration granted hereinabove is subject to the following conditions, namely: -(a)the certificate of registration shall be non-transferable;(b)the number of workmen employed or building workers in the establishment shall not, on any day, exceed the maximum number specified in the certificate of registration;(c)save as provided in these rules, the fees paid for the grant of registration certificate shall be non-refundable;(d)the rates of wages payable to building workers by the employer shall not be less than the rates prescribed under the Minimum Wages Act, 1948 (II of 1948) for such employment where applicable, and where the rates have been fixed by agreement, settlement or award, not less than the rates so fixed; and(e)the employer shall comply with the provisions of the Act and the rules made thereunder.FORM IIITHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rules 24 (2) and 25 (2)]REGISTER OF ESTABLISHMENTS
| Sl. No. |
Registration No. and date |
Name and Address, location of the establishment registeredwhere a building or other construction work is to be carried on
|
Name of the employer and his address |
Nature of building or other construction work |
| (1) |
(2) |
(3) |
(4) |
(5) |
| |
|
|
|
|
| |
| Name and permanent address of Establishment |
Probable date of commencement of work |
Maximum No. of building workers to be employed on any day |
Probable duration of building or other construction work &probable date of completion
|
Remarks |
| (6) |
(7) |
(8) |
(9) |
(10) |
| |
|
|
|
|
FORM IVTHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rules 26 (3) and 239 (1)]NOTICE OF COMMENCEMENT/COMPLETION OF BUILDING OR OTHER CONSTRUCTION WORK(1)(i)Name and address (Permanent) of the Establishment .............................(ii)Name of the employer and address .........................................................(2)Name and situation of place where the building and other construction is proposed to be carried on.(3)No. and date of Certificate of registration...............................................(4)Name and address of the person incharge of the construction work.(5)Address to which the communications relating to building or other construction work may be sent.(6)Nature of work involved and the facilities including plant or machinery provided.(7)The arrangement storage of explosives, if any, to be used in building or other construction work.(8)In case the notice is for commencement of work, the approximate duration of work.I/We hereby intimate that the building or other construction work (Name of work) having registration No ............................... dated........................ is likely to commence/is likely to be completed with effect from ........................................ (date)/on .................... (date).Signature of the EmployerTo,The Inspector,......................................FORM VTHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rules 56 and 74 (b), Schedule I]CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF WINCHES, DERRICKS AND THEIR ACCESSORY GEARTest Certificate No .........................................(a)In case of construction site, name of the construction site where lifting appliances are fitted/installed/located:
|
Situation and Description of lifting appliances and Gear withdistinguishing number or marks (if any), which have been tested,thoroughly examined
|
Angle to the horizontal derrick boom at which test loadapplied
|
Test load applied |
Safe working load at the angle shown in column (2) |
| (1) |
(2) |
(3) |
(4) |
| |
(Degrees) |
(Tonnes) |
(Tonnes) |
| |
|
|
|
| |
|
Name and address of public service, association, company, orfirm or testing establishment making the test and examination
|
Name and position of the Competent Person of public service,association, company or firm or testing establishment
|
| (5) |
(6) |
| |
|
I certify that on the ...............day of ........... 20....... the lifting appliance shown in column (1) together with its necessary gear was tested in the manner set forth overleaf in my presence; that a careful examination of the said lifting appliances after the test showed that it had withstood the test load without injury or permanent deformation; and that the safe working load of the said lifting appliance and accessory gear is as shown in column (4).Signature of the Competent PersonDate .............................................................................SealRegistration/Authority number of the Competent PersonFORM VITHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rules 56 and 74 (b)]CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF CRANES OR HOISTS AND THEIR ACCESSORY GEARTest Certificate No .........................................(a)Name of the construction site where cranes or hoists are fitted/located:
| Situation & description |
For jib cranes radius at the test load was applied |
Test load applied |
Safe working load for jib cranes at radius shown in column (2) |
| (1) |
(2) |
(3) |
(4) |
| |
(Metres) |
(Tonnes) |
(Tonnes) |
| |
|
|
|
| |
|
Name and address of public service, association or firm ortesting establishment making the test and examination
|
Name and position of the Competent Person of public service,association, company or firm or testing establishment
|
| (5) |
(6) |
| |
|
I certify that on the .....................day of..............20..... the above lifting appliances together with its accessory gear, was tested in the manner set forth overleaf that a careful examination of the said lifting appliance and gear after the test showed that it had withstood the test load without injury or permanent deformation; and the safe working load of the said lifting appliance and gear is as shown in column (4).
| Signature of the Competent Person |
Seal |
Date ............ |
| (See Note 3) |
|
|
| Registration/Authority number of the Competent Person |
|
FORM VIITHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rules 70 and 74 (b)]CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF LOOSE GEARSTest Certificate No .........................................(a)Name of the construction site where loose gears are fitted/located:
| Distinguishing Number or Mark |
Description, dimension and material of gear/device |
Number tested |
Date of test |
Test load applied (tonnes) |
Safe working load (SWL) (tonnes) |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
| Name and address of manufacturer or suppliers |
Initial test and examination certificate No. and date (only incase of periodical test and examination)
|
Name and address of public service association, company orfirm or testing establishment making the test and examination
|
Name and position of the Competent Person in public service,association, company or fir or testing establishment
|
| (7) |
(8) |
(9) |
(10) |
| |
|
|
|
I certify that on the ......................... day of .............20....... the above gear was tested and examined in the manner set forth overleaf; that the examination showed the said gear/device withstood the test load without injury or deformation; and that the safe working load of the said gear/device is as shown in column 6.
| Signature of the Competent Person |
Seal |
Date ............ |
| (See Note 3) |
|
|
| Registration/Authority number of the Competent Person |
|
FORM VIIITHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rules 62 and 74 (b)]CERTIFICATE OF TEST AND EXAMINATION OF WIRE ROPE BEFORE BEING TAKEN INTO USETest Certificate No ...............................(1)Name and address of maker or supplier(2)(a)Circumference/diameter or rope(c)Number of wires per strand(3)Quality of wire (e.g. Best Plough steel)(4)(a)Date of test of sample of rope(b)Load at which sample broke (tonnes)(c)Safe working load of rope (tonnes)(5)Name and address of public service, association, company or firm or testing establishment making the test and examination.(6)Name and position of Competent Person in public service, association, company or firm or testing establishment making the test and examination.I certify that the above particulars are correct, and that the test and examination were carried out by me and no defects affecting its safe working load (SWL) were found.
| Signature of the Competent Person |
Seal |
Date ............ |
| (See Note 3) |
|
|
| Registration/Authority number of the Competent Person |
|
FORM IXTHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001[See rules 72 and 74 (b)]CERTIFICATE OF ANNEALING OF LOOSE GEARSTest Certificate No ...............................(a)Name of the Construction site where loose gears are fitted/located:
| Distinguishing number or mark |
Description of gear |
Number of the certificate of test & examination |
Number annealed |
Date of annealing |
Defects found at careful inspection after annealing |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
|
Name and address of public service, association company orfirm or testing establishment carrying out the annealing andinspection
|
Name and position of the Competent Person of public service,association, company or firm or testing establishment
|
| (7) |
(8) |
| |
|
I certify that on the date shown in column (5) the gear described in columns (1) to (4) was effectually annealed under my supervision that after being so annealed every article was carefully inspected; and that no defects affecting its safe working condition were found other than those indicated in column (6).
| Signature of the Competent Person |
Seal |
Date ............ |
| (See Note 3) |
|
|
| Registration/Authority number of the Competent Person |
|
FORM XTHE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) RULES, 2001(See rules 69 and 73)CERTIFICATE OF ANNUAL THOROUGH EXAMINATION OF LOOSE GEARS EXEMPTED FROM ANNEALING(a)Name of the Construction site where loose gears are fitted/located:
| Distinguishing number or mark |
Description of gear |
Number of the certificate of initial and periodical test andexamination
|
Remarks |
| (1) |
(2) |
(3) |
(4) |
| |
|
|
|
| |
|
Name and address of public service, association, company orfirm or testing establishment carrying out the annealing andinspection
|
Name and position of the Competent Person of public service,association, company or firm or testing establishment
|
| (5) |
(6) |
| |
|
I certify that on the .......................................... day of ..........20....... the above gear, described in column (2) was thoroughly examined; and that no defects affecting its safe working condition were found other than those indicated in column (4).
| Signature of the Competent Person |
Seal |
Date ............ |
| (See Note 3) |
|
|
| Registration/Authority number of the Competent Person |
|
FORM XI[See rule 223 (c)]CERTIFICATE OF MEDICAL EXAMINATION
| 1. Certificate Serial No ................................ |
|
Date..................................................
|
|
2. Name........................................................
|
| Identification marks: |
(1) .................... |
| |
(2) ................... |
| 3. Father's Name ........................................... |
|
4. Sex............................................................
|
| 5. Residence ............................................. |
son/daughterof..................................................
|
|
6. Date of birth, if available....................................
|
and/or certificateage..........................................
|
| 7. Physical Fitness |
|
I hereby certify that I have personally examined (name) ........................................ son/daughter/wife of ....................... residing at................................. who is desirous of being employed in building and construction work and that his/her age as nearly as can be ascertained from my examination is ............................ years and that he/she is fit for employment in .................................................. as an adult/adolescent.8. Reason for
(1)refusal of certificate .......................................................(2)certificate being revoked ....................................................Signature/Left hand Thumb impression of building worker Signature with Seal Medical Inspector/C.M.O.Note. -1. Exact details of cause of physical disability should be clearly stated.
2. Functional/productive abilities should also be stated if disability is stated.
FORM XII[See rule 223 (d)]HEALTH REGISTER(In respect of persons employed in Building and other construction work involving hazardous processes)Name of the Construction Medical Officer/Medical Inspector.(a)Mr .....................................................From........................................to....................................(b)Mr .....................................................From........................................to....................................(c)Mr .....................................................From........................................to....................................
| Sl No. |
Work No. |
Name of building worker |
Sex |
Age (Last birthday) |
Date of employment of present work |
Date of leaving or transfer to other work |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
|
1.2.3.4.5.
|
|
|
|
|
|
|
| |
| Reason for leaving, transfer or discharge |
Nature of job or occupation |
Raw Material or by-product handled |
Date of Medical examination by certifying Surgeon MedicalInspector/CMO
|
Results of medical examination |
If suspended from work, state period of suspension withdetailed reasons
|
| (8) |
(9) |
(10) |
(11) |
(12) |
(13) |
| |
|
|
|
|
|
| |
|
Certified fit to resume duty on with signature of MedicalInspector/C.M.O.
|
If certificate of unfitness or suspension issued to worker |
| (14) |
(15) |
| |
|
Signature with date of Medical Inspector/CMONote. - (i) Column (8)-Detailed summary of reason for transfer or discharge should be stated.(ii)column (11) should be expressed as fit/unfit/suspended.FORM XIII[See rule 230 (a)]NOTICE OF POISONING OR OCCUPATIONAL NOTIFIABLE DISEASES
| 1. Name and address of the employer |
: |
| 2. Name of the building worker and his work No., if any |
: |
| 3. Address of the building worker |
: |
| 4. Sex and Age |
: |
| 5. Occupation |
: |
|
6. State exactly what the patient was doing at the time ofcontracting the disease
|
: |
|
7. Nature of poisoning or disease from which the buildingworker is suffering from
|
: |
| Date ................. |
Signature of the employer/CMO |
Note. - When a building worker contracts any disease specified in Schedule XII, a notice in this form shall be sent forthwith to the Chief Inspector of Inspections of Building and Construction.FORM XIV[See rule 210 (7)]REPORT OF ACCIDENTS AND DANGEROUS OCCURRENCES
| 1. Name of the project/work |
|
| 2. Location of project/work |
|
| 3. Stage of construction work |
|
| 4. Particulars of Employer |
|
| (a) Main contractor firm/Co: |
|
| Name |
|
| Address |
|
| Phone Nos. |
|
| Nature of business |
|
| (b) Sub-contractor's particulars: |
|
| Name |
|
| Address |
|
| Phone Nos. |
|
| Nature of business |
|
| 5. Particulars of injured person |
|
| (a) Name |
|
| (First) |
(Middle) |
(Surname) |
|
| (b) Home Address |
|
| (c) Occupation |
|
| (d) Status of the worker: |
|
| Casual |
|
| Permanent |
|
| (e) Sex: Male Female |
|
| (f) Age |
|
| (g) Experience |
|
|
(h) Marital status:Married/Unmarried/Divorced
|
|
| 6. Particulars of Accident |
|
|
(a) Exact place where accidentoccurred
|
|
| (b) Date |
|
| (c) Time |
|
|
(d) What the injured person wasdoing at the time of accident?
|
|
| (e) Weather condition |
|
|
(f) How long employed by you forthis particular job?
|
|
|
(g) Particulars ofequipment/machine/tool involved & condition of the same afterthe accident occurred
|
|
|
(h) Brief description of theaccident
|
|
| 7. Nature of injuries |
|
| (a) Fatal |
|
| (b) Non-fatal |
|
|
(c) If non-fatal, state preciselythe nature of injuries
|
|
|
(Describe in detail the nature of injury, for instancefracture of right arm, sprain etc.)
|
|
| (d) First-Aid: |
Given: |
Not given: |
|
| (e) If not, give the reasons |
|
|
(f) Name & designation of theperson by whom first-aid was given
|
|
| (g) If admitted to hospital, |
|
| Name of the hospital: |
|
| Address of the hospital |
|
| Phone No. |
Name of the Doctor |
|
8. Mode of transport used Ambulance Truck Tempo Taxi PrivateCar
|
|
| 9. How much time was taken to shift the injured person? |
|
| If very late, state the reasons |
|
| (b) How the reporting was made? |
|
|
Telephone Telegram SpecialMessenger Letter
|
|
|
(c) Who visited the accident sitefirst and what action was proposed by him?
|
|
|
(d) What are the actions taken forthe investigation of the accident by the employer? (Describeabout photographs/Video film/measurements taken, etc.)
|
|
| 10. Particulars of the persons given witness: |
|
| (a) Name |
Address |
Occupation |
|
| 1. |
|
| 2. |
|
| (b) Whether Temporary Permanent |
|
| 11. Particulars in case of fatal: |
|
| Date |
Time |
|
Whether registered with Buildingand other Construction Workers' Welfare Board
|
If yes, give Reg. No. |
|
12. Dangerous occurrences as covered under the Regulation No.(Give details)
|
|
|
(a) collapse or failure of liftingappliances, hoist conveyors, etc.
|
|
|
(b) collapse or subsidence ofsoil, any wall, floor, gallery, etc.
|
|
|
(c) collapse of transmissiontowers, pipeline, bridges, etc.
|
|
|
(d) explosion of receiver, vessel,etc.
|
|
| (e) fire and explosion |
|
|
(f) spillage or leakage ofhazardous substances
|
|
|
(g) collapse, capsizing, topplingor collision of transport equipment
|
|
|
(h) leakage or release of harmfultoxic gases at the construction site
|
|
|
(i) failure of lifting appliance,loose gear, hoist or building and other construction workmachinery, transport equipment, etc.
|
|
| 13. Certificate from the Employer or authorised signatory. |
|
|
I certify that to the best of myknowledge and belief, the above particulars are correct in everyrespect.
|
|
| Place ............ |
Signature |
| Date ............. |
Designation |
| c.c. forwarded for information and follow-up action: |
|
| 1. |
|
| 2. |
|
Note. - If more than one person is involved, then for each person, information is to be filled up in separate forms.FORM XV(See rule 240)REGISTER OF BUILDING WORKERS EMPLOYED BY THE EMPLOYER
|
Name and address of establishment where building and otherconstruction work is to be carried on
|
Name and permanent address of establishment |
|
Nature and location of work...................................
|
|
| Sl No. |
Name and Surname of workman |
Age and Sex |
Father's/Husband's name |
Nature of employment/designation |
Permanent Home address of workman (Village andTaluk and (Distt).
|
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
| Local Address |
Date of commencement of employment |
Signature or thump impression of workman |
Date of termination of employment |
Reasons for termination |
| (7) |
(8) |
(9) |
(10) |
(11) |
| |
|
|
|
|
| |
|
If the building worker is/was beneficiary, the date ofregistration as a beneficiary, the registration No. and the sameof Welfare Board
|
Remarks |
| (12) |
(13) |
| |
|
FORM XVI[See rule 241 (1) (a)]MUSTER-ROLL
| Name and permanent address of the establishment |
Name and address of establishment where building or otherconstruction work is carried on/is to be carried on
|
| Nature of building or other construction work |
Name and address of Employer |
|
For the month of........................
|
| Sl. No. |
Name of the building worker |
Father's/Husband's name |
Sex |
Dates |
Remarks |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
|
1.2.3.
|
|
|
|
|
|
FORM XVII[See rule 241 (1) (a)]REGISTER OF WAGES
|
Name and address of the establishment where building or otherconstruction work is carried on
|
Name and permanent address of establishment |
| Nature of building or other construction work |
Name and address of the employer Wage period: Monthly |
| Sl No. |
Name of workman |
Serial No. in the register of workman |
Designation/nature of work done |
No. of days worked |
Units of work done |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
| Daily rate of wages/piece rate |
Amount of wages earned |
| Basic wages |
Dearness allowances |
Overtime |
Other cash payments (nature of payment to beindicated)
|
Total |
| (7) |
(8) |
(9) |
(10) |
(11) |
(12) |
| |
|
|
|
|
|
| |
| Deductions, if any, (indicate nature) |
Net amount paid |
Signature/Thumb impression of workman |
Initial of employer or his representative |
| (13) |
(14) |
(15) |
(16) |
| |
|
|
|
FORM XVIII[See rule 241 (1) (a)FORM OF REGISTER OF WAGES-CUM-MUSTER-ROLL
|
Name and address of the establishment where building or otherconstruction work is carried on/is to be carried on
|
Name and permanent address of establishment |
| Nature of building or other construction work |
|
| Sl. No. |
Sl. No. in Register of building workers |
Name of employee |
Designation/nature of work done |
Daily attendance/units worked |
Total attendance/units of work done |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
| Daily rate of wages/piece rate |
Amount of wages earned |
| Basic wages |
Dearness allowances |
Overtime |
Other cash payments (nature of payment to beindicated)
|
Total |
| (7) |
(8) |
(9) |
(10) |
(11) |
(12) |
| |
|
|
|
|
|
| |
| Deductions, if any, (indicate nature) |
Net amount paid |
Signature/Thumb impression of workman |
Initial of employer or his representative |
| (13) |
(14) |
(15) |
(16) |
| |
|
|
|
FORM XIX[See rule 241 (1) (b)]REGISTER OF DEDUCTIONS FOR DAMAGE OR LOSS
|
Name and Address of establishment where building or otherconstruction work is carried on/is to be carried on
|
Name and permanent address of building worker |
Name and permanent address of the employer |
| Nature of building or other construction work |
|
|
| Sl. No. |
Name of work |
Father's/Husband's name |
Designation.nature of employment |
Particulars of damage or loss |
Date of damage or loss |
Whether building worker showed cause againstdeduction
|
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
| |
|
|
|
|
|
|
| |
|
Name of person in whose presence buildingworker's explanation was heard
|
Amount of deduction imposed |
No. of instalments |
Date of recovery |
| First instalment |
Last instalment |
| (8) |
(9) |
(10) |
(11) |
(12) |
| |
|
|
|
|
FORM XX[See rule 241 (1) (b)]REGISTER OF FINES
|
Name and address of establishment where building or otherconstruction work is carried on/is to be carried on
|
Name and permanent address ofestablishment
|
| Nature of building or other construction work |
Name and address of the Employer |
| Sl. No. |
Name of building worker |
Father's/Husband's name |
Designation/nature of employment |
Act/omission for which fine imposed |
Date of offence |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
| Whether building worker showed cause against fine |
Name of person in whose presence buildingworker's explanation was heard
|
Wage periods and wages payable |
Amount of the fine imposed |
Date on which fine realised |
Remarks |
| (7) |
(8) |
(9) |
(10) |
(11) |
(12) |
| |
|
|
|
|
|
FORM XXI[See rule 241 (1) (b)]REGISTER OF ADVANCES
|
Name and address of establishment where building or otherconstruction work is carried on/is to be carried on
|
Name and permanent address ofestablishment
|
| Nature of building or other construction work |
Name and address of the Employer |
| Sl. No. |
Name |
Father's/Husband's name |
Designation/nature of employment |
Wage period and wages payable |
Date and amount of advance given |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
| Purpose(s) for which advance given |
NO. of instalments by which advance to be repaid |
Date and amount of each instalment repaid |
Date on which last instalment was repaid |
Remarks |
| (7) |
(8) |
(9) |
(10) |
(11) |
| |
|
|
|
|
FORM XXII[See rule 241 (1) (c)]REGISTER OF OVERTIME
|
Name and address of establishment where building or otherconstruction work is carried on/is to be carried on
|
Name and permanent address ofestablishment
|
| Sl. No. |
Name of building worker |
Father's/Husband's name |
Sex |
Designation/nature of employment |
Date on which overtime worked |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
|
Total overtime worked or production in case ofpiece rated
|
Normal rates of wages |
Overtime rate of wages |
Overtime earnings |
Date on which overtime wages paid |
Remarks |
| (7) |
(8) |
(9) |
(10) |
(11) |
(12) |
| |
|
|
|
|
|
FORM XXIII[See rule 241 (2) (a)]WAGE BOOK
| Name and address of employer |
Name and permanent address ofestablishment
|
|
Name and address of the establishment where building or otherconstruction work is carried on
|
Nature of building or otherconstruction work
|
For the Week/Fortnight/Month ending ...................1. No. of days worked ..............................................
2. No. of units worked in case of piece-rate workers ...............
3. Rate of daily/monthly wages/piece-rate ..........................
4. Amount of overtime wages ........................................
5. Gross wages payable .............................................
6. Deductions, if any, on account of the following: -
(d)subscription towards provident fund(e)subscription towards the fund of the Building Workers' Welfare(f)any other deductions e.g. subscriptions to Co-operative Society or account of loans from Co-operative Society/housing loan, or contribution to any relief fund as per provision of clause (P) of sub-section (2) of section 7 of the Payment of Wages Act or for payment of any premium of Life Insurance Corporation7. Net amount of wages paid ...........................................
Initials of the Employer or his RepresentativeFORM XXIV[See rule 241 (2) (b)]SERVICE CERTIFICATE
| Name and permanent address of the establishment |
Name and address/location where the building or otherconstruction work carried on/to be carried on
|
| Nature and location of work |
.................................................................................... |
| Name and address of the workman |
.................................................................................... |
| Age or Date of Birth |
.................................................................................... |
| Identification Marks |
.................................................................................... |
| Father's/Husband's name |
.................................................................................... |
| Sl. No. |
Total period for which employed |
Nature of work done |
Rate of wages (with particulars of unit in caseof piece work)
|
If the building worker was a beneficiary hisregistration No., date and the name of the Board
|
| |
From |
To |
|
|
|
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
|
Reason/grounds on whichthe employment terminated
|
Remarks |
| (7) |
(8) |
| |
|
SignatureFORM XXV[See rule 243 (1)]ANNUAL RETURN OF EMPLOYER TO BE SENT TO THE REGISTERING OFFICERYear ending 31st December .....................1. Full name and full address of the establishment of the building and other construction work (Place, Post Office, District)
2. Name and permanent address of the establishment
3. Name and address of the employer
4. Nature of building and other construction work carried on
5. Full name of the Manager or person responsible for supervision and control of the establishment
6. Number of building workers ordinarily employed
7. Total number of days during the year on which building workers were employed
8. Total number of man-days worked by building workers during the year
9. Maximum number of building workers employed on any day during the year
10. The number of accidents that took place during the year as under:
(a)The total number of accidents.(b)The number of accidents resulting in disablement of building workers for less than 48 hours, the number of building workers involved and the number of man-days lost.(c)The number of accidents resulting in disablement of building workers beyond 48 hours but not resulting in any permanent partial or permanent total disablement, the number of building workers involved, and the number of man-days lost on account of such accidents.(d)The number of accidents resulting in permanent partial or total disablement, the number of building workers involved and the number of man-days lost on account of such accidents.(e)The number of accidents resulting in deaths of building workers and the number of resultant deaths.The Chief Inspector or Inspectors appointed by a State Government under the Act shall direct the owners of establishments registered under this Act, to send the copies of Annual Returns submitted by the employers of registered establishments in respect of the concerned State Government or appropriate Government to the Director General of Inspections by virtue of provisions of section 60 of the Act.The Chief Inspector or Inspectors appointed under this Act by a State Government shall direct the owners of such establishments as are registered under this Act by registering officers appointed by the concerned State Government to send copies of the Annual Returns to the Director General by virtue of provisions of section 60 of the Act.11. Change, if any, in the management of the establishment, its location, or any other particulars furnished to the Registering Officer in the application for Registration indicating also the dates.
EmployerPlace ................................Date .................................FORM XXVI[See rule 74 (b)]REGISTER OF PERIODICAL TEST-EXAMINATION OF LIFTING APPLIANCE AND GEARS ETC.Part I
Initial And Periodical Load Test Of Lifting Appliances And Their Annual Thorough Examination"Thorough examination" means a visual examination, supplemented, if necessary, by other means such as a hammer test, carried out as carefully as the conditions permit, in order to arrive at a reliable conclusion as to the safety of the parts examined, and if necessary, for such examination parts of the lifting appliances and gear shall be dismantled.(A)Initial and periodical load tests of lifting appliance
|
Situation and description of lifting appliancestested with distinguishing number of marks if any
|
No. of certificate of test and examination ofcompetent person
|
I certify that on thedate on which I have appended my signature the lifting applianceshown in column (1) was tested and no defects affecting its safeworking condition were found other than those shown in column (5)
|
Remarks (to be, signed and dated) |
| Date and signature with seal |
Date and signature with seal |
| (1) |
(2) |
(3) |
(4) |
(5) |
|
1.2.
|
|
|
|
|
(B)Annual thorough examination
|
I certify that on the date to which I haveappended my signature, the lifting appliance shown in column (1)was thoroughly examined and no defects affecting its safe workingconditions were found other than those shown in column (12)
|
| Date and signature with seal |
Date and signature with seal |
Date and signature with seal |
Date and signature with seal |
Date and signature with seal |
Date and signature with seal |
Remarks (to be signed and dated) |
| (6) |
(7) |
(8) |
(9) |
(10) |
(11) |
(12) |
| |
|
|
|
|
|
|
Note. - If all the lifting appliances are thoroughly examined on the same date it will be sufficient to enter in column (1) "All lifting appliances". If not, the parts which have been thoroughly examined on the dates must be clearly indicated.Part II
Initial And Periodical Load Test Of Loose Gears And Annual Thorough ExaminationList of loose gear:The following classes of loose gears namely: -1. Chains made of malleable cast iron;
3. Chains, rings, hooks, shackles and swivels made of steel;
5. Rings, hooks, shackles and swivels permanently attached to pitched chains, pulley blocks, container, spreaders, trays, slings, baskets, etc., and any other similar gear;
6. Hooks and swivels having screw-threaded parts or ball bearings or other case-hardened parts; and
7. Bordeaux connections.
INITIAL TEST AND PERIODICAL LOAD TEST OF LOOSE GEARS
| Distinguishing No. and marks |
Description of loose gear tested and examined |
No. of certificates of test and examination ofcompetent person
|
I certify that on the date to which I haveappended my signature the loose gears shown in columns (1) and(2) was thoroughly examined and and no defects affecting were itssafe working condition found other than those shown in column (6)
|
Remarks to be signed and dated |
| Date and signature with seal |
Date and signature with seal |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
|
1.2.3.4.5.
|
|
|
|
|
|
|
I certify that on the date to which I have appended mysignature, the loose gears shown in column (1) and column (2)were thoroughly examined by me and no defects affecting theirsafe working condition were found other than those shown incolumn (10)
|
| Date and signature with seal |
Date and signature with seal |
Date and signature with seal |
Remarks (to be signed and dated) |
| (7) |
(8) |
(9) |
(10) |
| |
|
|
|
Part III
Annealing Of Chains, Rings, Hooks, Shackles And Swivels (OTHER THAN THOSE EXEMPTED)(See Part II)
|
12.5 mm and smaller chains, rings, hooks, shackles and swivelsin general use. Other chains, rings, hooks, shackles and swivelsin general use.
|
If used with lifting appliancedriven by power, must be annealed once atleast in every sixmonths.If used solely with liftingappliance worked by hand, must be annealed once atleast in everytwelve months.If used with lifting appliancedriven by power, must be annealed once atleast in twelve months.If used solely with lifting appliance worked by hand, must beannealed once atleast in every two years.
|
Note. - It is recommended though not required by rules - that annealing should be carried out in a suitably constructed furnace heated to temperature between 1100 degree and 1300 degree Fahrenheit or 600 degree and 700 degree Centigrade, for a period between 30 and 60 minutes.
| Distinguishing No. or mark |
Description of gear annealed |
No. of the certificate of test and examination |
I certify that on the date to which I haveappended by signature, the gear described in column (1) andcolumn (2) was effectually annealed under my supervision; thatafter being so annealed every article was carefully inspected andthat no defects affecting its safe working condition were foundother than those shown in columns 7
|
Remarks to be signed and dated |
| Date and signature with seal |
Date and signature with seal |
Date and signature with seal |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
| |
|
|
|
|
|
|
FORM XXVIIAPPLICATION FOR REGISTRATION[See rule 266 (4)]
| 1. Name |
: |
|
| 2. Address |
: |
|
| 3. Whether SC/ST |
: |
|
| 4. Name of Father |
: |
|
| 5. Marital Status |
: |
(Married, Unmarried or widow) |
| 6. Date of birth |
: |
|
|
7. Name, address and Register No. of the Establishment wherethe applicant is working
|
: |
|
| 8. E.S.I./P.F. No. |
: |
|
| 9. Name and address of employer |
: |
|
| 10. Total service |
: |
|
| 11. Rate of subscription |
: |
|
| 12.Name of Bank and Branch, where subscription is to be paid |
: |
|
|
13.If the applicant is already a member of any other WelfareBoard, the name of such Boards and registration No. of theapplicant.
|
: |
|
|
The above facts are true to the best of my knowledge andinformation.
|
| Place .................... |
|
Signature of the applicant. |
| Date ..................... |
|
Name and Signature of Employer. |
FORM XXVIIINOMINATION FORM[See rule 266 (7)]I nominate the following person/persons as rightful dependants, to receive all the dues from the Fund on my behalf and in the event of my death, as rightful heirs to receive all benefits due to me.
| Name & Address of Nominee/Nominees |
Relationship with member |
Age of Nominee |
Amount to be given to each Nominee |
| |
|
|
|
Place ...................Name, Address Regn. No. & Address of the workerFORM XXIXDELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD(See rule 274)
| Application No. |
: |
Fee Rs. |
| APPLICATION FOR HBA |
| 1. (a) Name of the applicant |
: |
|
| (b) Permanent Address |
: |
|
| (c) Present Address |
|
|
| 2. Date of Birth |
: |
|
| 3. Date of retirement |
: |
|
| 4. (a) Register Number |
: |
|
| (b) Date of Registration |
: |
|
| (c) Rate of remittance |
: |
|
| (d) Date of first remittance |
: |
|
| (e) Date of last remittance |
: |
|
| (f) Total amount remitted |
: |
|
|
(g) Whether the membership hasEver been revived, if so details
|
: |
|
| (h) Details of revival |
: |
|
|
5. Purpose of advance (new construction/Maintenance/Purchaseof land with Building)
|
: |
|
| 6. Whether the applicant has a house of his own (give details) |
: |
|
| 7. Amount of advance required |
: |
|
| 8. Details of land property |
: |
|
| (a) Panchayat/Town |
: |
|
| (b) Village |
: |
|
| (c) Taluk |
: |
|
| (d) District |
: |
|
| (e) Area |
: |
|
| (f) Survey No. |
: |
|
| (g) Valuation of the property |
: |
|
|
9. Whether the applicant has received Any other loan for HBA,give details
|
: |
|
|
10.Estimate for construction/Maintenance of building as perplan
|
: |
|
| 11. Details of the amount raised apart from the loan |
: |
|
|
12. Whether the applicant has received Loan previously fromthis Board
|
: |
|
DECLARATIONI hereby declare that the above statements are true and correct to the best of my knowledge and belief.Place ....................Signature....................Date .....................Name .........................Details of documents to be produced:1. Plan and estimate (approved)
2. Encumbrance Certificate of 14 years
6. Attested copy of ration card (Page 2, 4) for maintenance application.
7. Ownership of the building (for maintenance only)
8. Terminal benefit declaration
9. Attested copies of identity card and passbook
10. Title clearance certificate
11. Age certificate of the building (for maintenance only)
12. Valuation certificate of the building (for maintenance only)
13. No objection certificate from the authorities for construction.
14. Declaration from the applicant that neither he/she/nor his/her spouse or children own a house (for new construction).
MORTGAGE DEEDThis Deed of Mortgage is executed on this the .................... day of ................. two thousand hundred and ........................... by Shri/Smt............................. son/daughter/wife of ........................ aged................... residing................ at .................... Village...................... Taluk.................... District...................... and Shri/Smt ............................ son/daughter/wife of Shri ..................................... aged.....................residing at.............................. village ............................. Taluk...................... District............................... (Thereinafter called the Mortgagor/Mortgagors which expression shall include his/her/their executers, administers, legal representatives and assigns) in favour of the Delhi Building and Other Construction Workers Welfare Board established under the Building and Other Construction Workers Welfare Act and having its Chief Office at Delhi (thereinafter called 'the Mortgage' which expression shall include its successors or assigns wherever the context or meaning thereof shall so require or permit).Whereas the Mortgagor/Mortgagors has/have applied to the Mortgage for a loan of Rs. 50,000 (Rupees fifty thousand only for the construction of a house on the land, more particularly mentioned and described in the Schedule hereunder written: -And whereas on the request of the Mortgagor/Mortgagors the Mortgagee has agreed to lent an advance in two instalments to be mortgager a loan of Rs. 50,000 (Rupees fifty thousand only) subject to the covenants, terms and conditions herein contained and having the repayment thereof, secured in the manner hereinafter expressed.NOW THIS DEED WITNESSETH AS FOLLOWS:1. In pursuance of the said agreement and in consideration of the sum of Rs. 50,000 (Rupees fifty thousand only) now lent and advance/and paid by the Mortgagee to the Mortgagor/Mortgagors, (the receipt whereof the Mortgagor hereby admits and acknowledges) the Mortgagor/Mortgagors hereby transfers/transfer by way of simple Mortgage the immovable property, more particularly mentioned and described in the schedule hereunder written together with the building to be constructed thereon and other improvements thereon from time to time to the intent that of the said property and the building and other improvements shall remain and be charged as security for payment to the Mortgagee of the said loan amount interest and cost and the Mortgagee shall have the first charge over the same.
2. The loan amount shall be paid to the Mortgagor/Mortgagors by the Mortgagee in two instalments that the first instalment of a sum of Rs. 20,000 (Rupees twenty thousand only) equal to 40% of the loan sanctioned shall be paid to the Mortgagor/Mortgagors for starting construction, that the 2nd and final instalment of Rs. 30,000 (Rupees thirty thousand only) equal to 60% of the loan shall be paid after completing the construction of roof and on starting finishing works. The construction of the building shall be completed in all respects utilizing the 2nd instalment and certificate of completion shall be produced within two months from the receipt of last instalment.
3. The instalments shall be paid only subject to the availability of funds and the non-payment of amounts due to paucity of funds shall not entitle the Mortgagor/Mortgagors to realize any loss that he/she/they may sustain on that account from the Mortgagee.
4. The Mortgagor/Mortgagors hereby assures/assure upto the Mortgagee that he/she/they is/are the absolute owners of the property mentioned in the schedule hereto and that they are free from any encumbrance or charge of any description, whatsoever or any attachment or restraints on alienation.
5. The Mortgagor/Mortgagors shall not at any time during the continuance of this security create any Mortgage lien or charge by way of hypothecation, pledge or otherwise create encumbrance of any kind whatsoever in respect of the properties described in the schedule hereto or any part thereof, or let or lease them except with the prior permission in writing of the Chief Executive Officer, Delhi Building and Other Construction Workers Welfare Board until the whole amount with interest are fully repaid.
6. The loan shall bear interest at the rate of 5% per annum or such other higher rate of interest as may be fixed by the Mortgage from time to time.
7. The loan shall be repaid by the Mortgagor/Mortgagors in monthly instalments at the rate as would be fixed and intimated by the Mortgagee. The first instalment becoming due on the expiry of 6 months from the date of disbursement of the first instalment, subsequent instalments shall be paid on or before the 10th day of succeeding month for 167 months. Any interest due on the loan amount outstanding on the date of payment of an instalment shall be paid along with the instalment.
8. At the time of disbursement of the 2nd instalment the Mortgagee shall deduct the interest and other expenses due on the 1st instalment till the date of payment of the 2nd instalment. If the Mortgagee pays only a part of the loan amount to the Mortgagor due to the non-availability of funds such part of the loan shall be repaid by the Mortgagor in instalments at the rate as would be fixed and intimated by the Mortgagee.
9. If the Mortgagor/Mortgagors dies/die before the disbursement of the remaining instalments of the loan after having received one or more instalments of the loan and if his/her/their heir or heirs executor/executors refuses/refuse to avail of the remaining instalment and also refuses or refuse to complete the construction of the house according the approved plan and estimate within one year after the date of disbursement of the first instalment of the loan the whole loan advance with interest shall be liable to be summarily recovered by proceedings against the property movable or immovable of the deceased Mortgagor/Mortgagors under the provisions of the revenue recovery at for the time being enforced and the relevant provisions of the Delhi Building and Other Construction Workers Welfare Rules, as if some were arrears of public revenue due on land or in such other manner as the Mortgagee may deem fit.
10. If the heir/heirs executors of the deceased Mortgagor/Mortgagors does/do not require the balance instalments of the loan and are, however willing to complete the construction at her/his/their cost, the amount already paid to the Mortgagor/Mortgagors out of the sanctioned loans will be treated as the actual amount of the loan sanctioned and the recovery shall be effective at the rate of instalment prescribed for that amount of loan.
11. The Mortgagor/Mortgagors shall remit the instalments in the Banks prescribed by the Mortgagee in the manner specified for this purpose or by the challans prescribed by the Delhi Building and Other Construction Workers Welfare Board.
12. If any instalment of principal or interest is not remitted on the due dates a penal interest at the rate of 5% in addition to the usual rates shall be paid and such amount as are not paid on due dates.
13. The loan amount shall be utilized only for the purpose for which it is sanctioned. Each instalment of the loan referred to in Clause II above shall be utilized within the time limit prescribed. In case the Mortgagor/Mortgagors fails/fail to claim the subsequent instalment within three months from the drawal of the previous instalments such previous instalment shall be treated as the last instalment unless the time is extended by the mortgagee and recovery shall commence as provided in the terms and conditions prescribed for the grant of the loan.
14. If the Mortgagor/Mortgagors fails/fail to utilize any instalment of loan within the maximum period admissible and does not apply for subsequent instalment of loan as provided in the conditions the entire amount already disbursed shall be recoverable from him/her/them with interest in lump sum.
14. (a) If the Mortgagor/Mortgagors is/are found to have failed in utilizing the amount for the construction of house as specified in the mortgage deed within the prescribed period, the mortgagee is entitled to realize the entire loan amount plus other charges with interest in a lump after the issuance of a registered notice directing to pay the amount within a period of 30 days.
(i)If the Mortgagor/Mortgagors repay the amount due in lump sum within the stipulated period the mortgage deed shall be released.(ii)If the Mortgagor/Mortgagors fails/fail to repay the amount due within the period of 60 days as stipulated above the mortgagee will have the right to take step to realize the entire dues to the Board in lump. In addition to that a penalty not exceeding 5% of the loan amount actually received by the loanee or Rs. 1000 (Rupees one thousand only) whichever is higher shall also be realized from the Mortgagor/Mortgagors.15. In the event of any information furnished in the application being found false or materially incorrect, the Mortgagee shall be cancel the loan and recover the entire amount outstanding in lump with interest accrued thereon by selling the mortgaged property besides taking such legal action against the borrower as may be considered desirable.
16. The Mortgagor/Mortgagors shall not alter or modify the building constructed in accordance with the plan approved by the Mortgagee so as to diminish the value of the property or construct any other building in the property, offered as security till the entire amount with interest are repaid.
17. In case of the Mortgagor/Mortgagors at any time make default in the payment of two consecutive instalments or commits breach of all or any of the terms and conditions contained herein the balance of the principal of sum which shall for the time being remain unpaid together with interest accrued thereon and all sums found due to the Mortgagee under or by virtue of these presents shall forthwith become payable in a lump at once and in case of default of payment of the whole sum immediately the Mortgagee shall have power without the intervention of any court to take possession of the Mortgaged property and to sell the same. The balance of the sale proceeds after adjusting all amounts due to the Mortgagee will be disbursed to the Mortgagor. The Mortgagee shall also have all the powers vested in the Mortgagee under the provision of the Transfer of Property Act, 1882.
18. Without prejudice to any or all of the other rights and remedies of the Mortgagee all sums found due to the Mortgagee under or by virtue of these presents shall be recoverable from the Mortgagor/Mortgagors and his/her/their properties, movable and immovable under the provisions of the Revenue Recovery Act for the time being in force as though they are arrears of Public Revenue due on land and in accordance with the relevant provision of the Delhi Building and Other Construction Workers Act in any other manner as the Mortgagee may deem fit.
19. The Mortgagor/Mortgagors shall be bound by the terms of the application form and the conditions attached thereto which shall form part of this deed as if they are incorporated on this deed.
20. This Mortgage has been fully explained to the Mortgagor/Mortgagors and the Mortgagor/Mortgagors has/have executed these presents fully understanding the implications thereof and all his/her/their obligations thereunder and after receiving such advice.
THE SCHEDULE ABOVE REFERRED TO(here enter details of all land and buildings)IN WITNESS WHEREOF Shri ............................................ the Mortgagor(s) here to set his/her/their hands the day and year first above, written and signed by Shri/Smt .................................. in the presence of witness:2.
Signed by Shri/Smt ..................................... in the presence of witnesses:2.
STAGE CERTIFICATE FOR RELEASE OF SECOND INSTALMENT OF ADVANCE SANCTIONED BY THE DELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD UNDER HOUSING LOAN SCHEME
| BENEFICIARY |
PROPERTY |
| 1. Regn. No ............................ |
District...................................... |
| 2. Name ................................ |
Taluk......................................... |
| 3. Address ............................. |
Village....................................... |
| 4. Signature ........................... |
Sy. No........................................ |
The Construction of building in the property detailed above by the beneficiary specified above has reached/completion of foundation basement and on completion work upto lintel level/completion of the lintel work/completion of the linter work and 50% of the work of the roof and stored the materials for the work of shutters/completion of the roof work and has been completed 40% of the finished work as per the plan and the beneficiary is eligible for the second instalment of the loan sanctioned by the Delhi Building and Other Construction Workers' Welfare Board.Certified that the work valued at Rs ...................... has been carried out by the beneficiary as on ..............................Place ...................Signature of District, Executive Officer/T.E.O. or any Authorised Officer with name & designation.Date ....................Name of Office.FORM XXXDELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD[See rule 268 (3)]Return for the month of .................. regarding the details of workersName and Address of the Establishment :
| Sl. No. |
No. of workers as on the close of previous month |
No. & Name(s) of worker(s) who left serviceduring the month
|
No. & Name(s) of worker(s) to be registered |
No. of workers as on the close of current month |
| |
|
|
|
|
Place ...................Name and Signature of the EmployerDate ....................(Office Seal)FORM XXXIDELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD[See rule 268 (3)]PARTICULARS OF ESTABLISHMENT
| 1. Name of the Establishment |
: |
|
2. Nature of Establishment Whether Company/PartnershipFirm/sole proprietorship
|
: |
| 3. Names of the partners/Directors/Proprietor |
: |
|
4. Name of Managing Partner/Managing Director/Person who is inultimate control of the establishment
|
: |
| 5. Details of branches |
: |
| 6. Details of occupiers |
: |
|
Place ...................Date ....................
|
|
Name, Signature and Designation |
| |
|
(Office Seal)FORM XXXIIFORM OF IDENTITY CARD[See rule 268 (8)]
| PAGE I |
|
| PHOTO |
|
|
|
Signature, date and official designation of the registeringauthority (with office seal)
|
|
|
| PAGE II |
|
| Name of Member |
: |
|
| Address |
: |
|
| Male/Female |
: |
|
| Name of Job |
: |
|
| Registration No. |
: |
|
| District |
: |
|
| Date of Registration |
: |
|
| Name of Bank & Branch in which subscription is to be paid |
: |
|
| Subscription rate: Rs. 20 |
: |
|
| PAGE III |
|
| Date of birth |
: |
|
| Completed age |
: |
|
| Date of retirement |
: |
|
| Marital Status Married/Unmarried |
: |
|
| Name of Wife/Husband |
: |
|
| Address |
: |
|
| Whether wife/husband, a Member of this Board |
: |
Yes/No |
| If so, name and registration Number |
: |
|
| Name of Nominees |
: |
|
| Relationship with the member |
: |
|
| Signature/Thumb impression of the member |
: |
|
| Official designation and signature of registering authority. |
|
|
FORM XXXIIIREGISTER OF IDENTITY CARD[See rule 266 (8)]Name of district ...........................
| Sl.No. |
No. of Identity Cards |
Date of issue |
Name and address of of the worker |
Signature of District Executive Officer |
Remarks |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
FORM XXXIV(See rule 271)APPLICATION FOR MATERNITY BENEFIT
| 1. Name and address of applicant |
: |
| 2. Registration No. |
: |
| 3. Age and date of birth |
: |
| 4. Name of husband |
: |
| 5. Date of confinement |
: |
| 6. Have you applied for this benefit earlier |
: |
| 7. If so how many times and give details |
: |
| 8. Date of registration |
: |
| 9. Date of payment of 1st subscription and amount |
: |
| 10. Date of payment of last subscription |
: |
| 11. Name of bank and place |
: |
| 12. List of Documents submitted |
: |
|
(a) Copy of Challans or copy ofpass book
|
|
|
(b) Medical certificate inoriginal.
|
|
|
The facts furnished above are trueto my knowledge and information.
|
| Place ....................... |
Name and signature of applicant |
| Date ....................... |
|
FORM OF MEDICAL CERTIFICATE(To be obtained for a Medical Officer not below the rank of an Assistant Surgeon)I have examined Smt . ......................................age ............... and wife of Shri ..................................... she is pregnant running ......................................month. She had delivered a child on ......................................Place ...................... Name of Doctor & SealDate .......................FORM XXXV[See rule 273 (1)]APPLICATION FOR PENSION
| 1. Name and address of applicant |
: |
| 2. Registration No. |
: |
| 3. Date of completion of 60 years |
: |
| 4. Date of payment of Ist subscription amount and name of bank |
: |
| 5. Default if any and reasons thereof |
: |
|
6. Date of payment of last subscription amount, date and nameof bank
|
: |
| 7. List of documents |
: |
| (a) Identity Card |
|
| (b) Pass Book |
|
| (c) Challans |
|
| 8. Address at which pension is to be sent |
: |
|
9. Any other information (Details of benefit if any, fromother welfare Boards)
|
: |
|
The facts mentioned above are true to my knowledge andinformation.
|
| Place ........................ |
Name and signature of applicant |
| Date ........................ |
|
FORM XXXVI[See rule 273 (6)]REGISTER OF PAYMENT OF PENSION
| PPO No. |
Name & address of the pensioner with MembershipNO. in The D.B.O.C.W.W. Board
|
Date of Birth |
Date of retirement |
Total service |
| Date of entry in the scheme |
| (1) |
(2) |
(3) |
(4) |
(5) |
| |
|
|
|
|
| No. & date of order of sanctioning Authority |
Date of commencement of pension |
Monthly rate of pension Rs. |
Dated-initial of |
RemarksOrder on cancellation of pension etc. May be notedhere with reason and date Effect under initials of Secretary/DEO
|
| Secretary/D.E.O. |
| (6) |
(7) |
(8) |
(9) |
(10) |
| |
|
|
|
|
| Details of Pension Paid |
| Month/Year |
Amount of Pension |
Date of sending of Money Order |
Dated-initials of D.E.O./S.S |
Remarks (Details of undelivered H.O. etc. may benoted here
|
| (11) |
(12) |
(13) |
(14) |
(15) |
| |
|
|
|
|
FORM XXXVII[See rule 279 (1)]APPLICATION FOR DEATH BENEFIT
| 1. Name and address of applicant |
: |
| 2. Relationship with worker |
: |
| 3. Name and address of the worker |
: |
| 4. Registration No. |
: |
| 5. Age & Date of Birth |
: |
| 6. Worker whether married |
: |
| 7. Nature of Death (Give details) |
: |
| 8. Details of documents submitted |
: |
| 9. Amount of financial assistance applied for |
: |
|
The above details are true to myknowledge and information.
|
| Place ....................... |
Name and signature |
| Date ...................... |
|
FORM XXXVIII[See rule 279(4)]REGISTER OF DEATH BENEFIT
| Sl. No. |
Date of receipt of application |
Name and Register No. of worker |
Period of remittance |
Date of death |
Order No. and date |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
| |
|
Name & address of nominee with Relationshipto Member
|
Amount of Death Benefit |
Refund of Amount |
Total |
Initial |
| (7) |
(8) |
(9) |
(10) |
(11) |
| |
|
|
|
|
FORM XXXIX[See rule 275 (2)]APPLICATION FOR DISABILITY PENSION
| 1. Name and address of applicant |
: |
| 2. Age and date of birth |
: |
| 3. Registration No. |
: |
|
4. Date of payment of first subscription amount and Name ofBank & Branch
|
: |
|
5. Date of payment of last subscription amount and Name ofBank
|
: |
| 6. Total amount of subscription |
: |
| 7. Details of disease/accident |
: |
| 8. Nature of disability due to disease/accident |
: |
| 9. Details of treatment in Government hospitals |
|
| Date of admission and date of discharge |
: |
|
10. Whether the patient was in plaster? If so, for how manydays?
|
: |
|
11. Amount spent for treatment (should be supported by medicalbills countersigned by the treating doctor)
|
: |
| 12. List of documents submitted |
: |
| 13. Details of benefits received, if any before |
: |
|
14. Details of benefits received, if any from Government orany other institution, for the above treatment.
|
: |
| The above facts are true to my knowledge and information. |
| Place ......................... |
Name and signature of applicant |
| Date ......................... |
|
FORM XL[See rule 276]
| Application No. |
Fee Rs. |
| APPLICATION FOR INSTRUMENT LOAN |
| 1. Name of the Applicant |
: |
| 2. Father's/Husband's Name |
: |
| 3. Residential Address |
: |
| 4. Register No. |
: |
| 5. Name of Bank in which contribution remitted |
: |
| 6. Age & Date of Birth |
: |
| 7. Monthly Income |
: |
|
8. Details of other properties if any, owned or possessed bythe applicant
|
: |
| 9. DETAILS OF SURETIES: |
|
| Name & Address |
: |
| Occupation & Address |
: |
| Age & Date of Birth |
: |
| Present net monthly income |
: |
|
Details of other propertiesOwned/possessed by the surety
|
: |
|
Whether the surety has offeredhimself as surety for any other transaction earlier, if so, thedetails
|
: |
| 10. Whether salary certificate from the employer is attached |
: |
| 11. Particulars of Instruments to be purchased |
: |
| (a) Description |
|
| (b) Make |
|
| (c) Model |
|
| (d) Invoice price (copy enclosed) |
|
|
(e) Name & Address ofsupplier/dealer
|
|
| 12. (a) Amount of loan applied for |
: |
|
(b) No. of monthly instalmentsproposed for repayment
|
: |
DECLARATIONA. I/We confirm that the funds will be used for the stated purpose only and will not be used for speculation and/or anti-social purpose.B. I/We understand that the Board has the right to recall the funds if they are not used for the stated purpose.C. I/We understand that the sanction of the facility is at the discretion of the Board and I/We will execute necessary Security Documents as per the Board's requirements to its satisfaction.Place ........................Signature of applicantDate .........................Surety 1. Name and Signature(For Office Use. only)The application submitted by Shri .................................employed as .................................in .................................has been verified. The certificate of employment and surety in respect of the borrower/surety has been attached along with the undertaking by the employer.An amount of Rs . .................................(Rupees .................................) may be sanctioned for the purpose being the amount requested/amount eligible 75% of the invoice amount to be recovered of Rs .................................. (Rupees ...........................) in .................................equal monthly instalments. The last instalment will be the amount outstanding after remittance of the .................................instalment including other dues to the Board at the time of closing of the loan amount.Sanctioned/Rejected District Executive OfficerSecretaryDELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD(GOVERNMENT OF N.C.T. OF DELHI)EMPLOYMENT CERTIFICATECertified that Shri/Smt ..................................S/o, D/o, W/o ................................. of ................................. House No. ................................. Town ................................. Desam ................................. Village................................. Taluk ................................. District ................................. now residing at House No.................................. Town/Desam ................................. Village................................. Taluk................................. District ........................... is a permanent/officiating/acting/provisional....................... (Designation).
|
DETAILS OFHIS/HER SERVICE ARE AS UNDER
|
|
1. Date of entry into service.................................
|
|
2. Date of which continuousservice begins .................................
|
|
3. Date of retirement.................................
|
|
DETAILS OFHIS/HER PAY, ETC. ARE AS UNDER
|
|
1. Basic pay...........................
|
(a) ProvidentFund...............................
|
|
2. Dearness Allowance..................
|
(b) LICrecoveries.................................
|
|
3. HRA.................................
|
(c) IncomeTax.....................................
|
|
4. Compensatory Allowance..............
|
(d) Loan recoveries |
| |
1....................................................
|
| |
2....................................................
|
| |
3....................................................
|
|
5. Other Allowances...............................
|
(e) Other recoveries |
| |
1....................................................
|
| |
2....................................................
|
|
Total (A).................................
|
Total(B).................................
|
| Net Salary: |
(A)-(B) Rs..................................
|
| Place .................... |
Signature |
| Date ..................... |
Name |
| |
(Office Seal) |
Designation of the Head of Office/department |
UNDERTAKING FOR RECOVERY FROM PAYI .................................(Name in full) ................................. (Office/department) owe to Delhi Building and Other Construction Workers' Welfare Board, the sum of Rs. .................................(Rupees .................................) borrower has undertaken to repay in equated monthly instalments of Rs ..................................on.................................the day of every month, I hereby agree that in case of default of payment of monthly instalments in connection with the said transactions monthly recoveries of such amounts as may be fixed by the Board from time to time of which information will be given by the Board may be made from my salary at source and remitted or paid to the Board or its duly authorised representatives.Place ...................... Signature of employeeDate ......................I agree to effect the above recoveries.Place ........................Signature of the Head of Office/ DepartmentDate ........................(Office Seal)FORM XLI(See rule 277)APPLICATION FOR FUNERAL BENEFIT
| 1. Name and address of applicant |
: |
|
| 2. Relationship of applicant with the worker |
: |
|
| 3. Name and address.of worker |
: |
|
| 4. Registration No. |
: |
|
| 5. Date of registration |
: |
|
|
6. Date of payment & first subscription,: amount and nameof bank, branch
|
: |
|
|
7. Date of payment of last subscription, amount, name of bank,branch
|
: |
|
| 8. Duration of membership |
: |
|
| 9. Whether membership was live? |
: |
|
| 10. Date of death of the worker |
: |
|
| 11. Reason for death |
: |
|
| 12. Whether applicant is the nominee of the worker |
: |
|
|
13. If not, whether the applicant has submitted dependencecertificate
|
: |
|
| 14. Name, age and date of birth of the nominee |
: |
|
|
15. If nominees are minor, name of guardian and hisrelationships with the children
|
: |
|
|
16. Whether consent letters from other nominees submitted?(Where the No. of nominees is more than one)
|
: |
|
|
17. Whether certificate of guardianship submitted by the minorchildren
|
: |
|
| 18. Amount of benefit, applied for |
: |
|
|
The above facts are true to mybest of knowledge and information.
|
| Place ......................... |
|
Name and address ofapplicant
|
| Date ......................... |
|
|
| FORM XLII |
| (See rule 280) |
| APPLICATION FOR MEDICAL BENEFIT |
| 1. Name and address of applicant |
: |
|
| 2. Age and date of birth |
: |
|
| 3. Registration No. |
: |
|
|
4. Date of payment of first subscription Amount and Name ofBank
|
: |
|
|
5. Date of payment of last subscription Amount and Name ofBank
|
: |
|
| 6. Total amount remitted |
: |
|
| 7. Details regarding disease/surgery |
: |
|
| 8. Disability if any, due to disease or surgery |
: |
|
|
9. Period of treatment as patient in Government Hospitals(Date of admission in the Hospital and date of discharge)
|
: |
|
| 10. List of documents submitted |
: |
|
| 11. Details of medical benefits received, if any before |
: |
|
|
The facts mentioned above are trueto my knowledge and information.
|
| Place ...................... |
|
Name and address ofapplicant
|
| Date ....................... |
|
|
| FORM XLIII |
| (See rule 281) |
| APPLICATION FOR EDUCATION SCHOLARSHIP |
| 1. Name of student |
: |
|
| 2. Male/Female |
: |
|
| (a) SC/ST |
: |
|
| (b) Whether proof is attached |
: |
|
| 4. Name of college and affiliated University/ Board |
: |
|
| 5. Name and year of course |
: |
|
| 6. Date of admission to the course |
: |
|
| 7. Age & date of birth of the student |
: |
|
| 8. Details of qualifying examination passed |
: |
|
| Name of Exam. |
Name of affiliated University/Board/State |
Month & year ofpassing qualifying examination
|
| 9. Marks scored in the qualifying examination |
|
Maximum marks |
| Subject |
Marks Scored |
Maximum marks |
Percentage |
| Total marks |
|
|
| 10. (a) Name of parent of applicant |
: |
|
| (b) Registration No. |
: |
|
|
(c) Date of payment of firstsubscription
|
: |
|
|
(d) Date of payment of lastsubscription
|
: |
|
|
(e) No. of instalments paid Totalsubscription paid
|
: |
|
| (f) Permanent address |
: |
|
|
(g) Has the membership been Yes/Norevived
|
: |
Yes/No |
| If so, period of revival |
: |
|
|
The facts mentioned above are true to my knowledge. Ifselected for the scholarship, I promise that I will abide by thecondition stipulated in the Scheme.
|
| Place ..................... |
|
Name and signature of the student |
| Date ...................... |
|
|
AFFIDAVIT OF THE PARENT OF THE STUDENTI (Name and address) S/o or D/o (Name and address) ................................... solemnly affirm the following:1. My son/daughter Shri/Smt . ................................... is studying for ................................... (name and years of course).
2. I am a member of the Board since ................................... (Year) with registration No.
3. Subscription has been paid upto ...................................
4. If any of the above facts are found to be wrong later, the scholarship amount granted to the student will be remitted back by me. The decision of Secretary in this regard will be applicable to me and it will be final and I agree with the same.
5. I also agree to recover any amount of default due from me.
Place ...................Name and signatureDate ....................(To be signed before MLA/MP/Panchayat President/Gazetted Officer of State or Central)I certify that Smt./Shri ................................... who has signed above has put the signature in my presence.Place .................... Attesting OfficerDate ..................... Name(Seal)Official designationI ................................... head of ................................... (Name of institution) hereby certify that Smt./Shri ................................... is a ................................... year student of ................................... course. I have examined the application submitted by the student and I am convinced that it is correct. This institution is affiliated to the ...................................university/Board.(Office Seal)Signature of Principal/HeadPlace ...................NameDate ....................Official DesignationENQUIRY REPORT OF DISTRICT EXECUTIVE OFFICER1. Shri/Smt . ................................... is a live member of this Board, having registration No .................................... and is paying subscription regularly.
2. He has paid subscription regularly from ...................................to ................................... He has not defaulted payment of subscription. Membership has been revived for the period from ...................................to ................................... I recommend/do not recommend the application (reason for rejection).
District Executive OfficerFORM XLIV(See rule 282)APPLICATION FOR MARRIAGE ASSISTANCE
| 1. Name of applicant |
: |
| 2. Address |
: |
| 3. Registration No. |
: |
| 4. Age and Date of Birth |
: |
|
5. Date of payment of first subscription, amount & name ofBank and branch
|
: |
|
6. Date of payment of last subscription, amount, name of Bankand branch
|
: |
| 7. Duration of membership |
: |
| 8. Is membership live? |
|
| 9. If application is for the marriage of Son/Daughter |
|
|
(1) Whether husband or wife, amember of this Board
|
: |
|
(2) If so, has she/he applied forthe financial assistance
|
: |
|
(3) Date of birth of the son/daughter who is getting
|
: |
|
(4) Address of the bride orbridegroom of the son/ daughter
|
: |
| (5) Date and place of marriage |
: |
|
(6) Date & No. of theCertificate of marriage
|
: |
|
Name and address of the authoritywho issued the Certificate
|
: |
|
(7) Have you applied for financialassistance for the marriage of any other son/daughter; if so,details of the same
|
: |
|
10. If application is for the Marriage of self (for womenworker only)
|
|
|
(1) Name and address ofhusband/bridegroom
|
: |
| (2) Date & place of marriage |
: |
|
(3) No. & Date of Marriagecertificate
|
: |
|
Name of authority who issued thecertificate
|
|
|
11. Are you in receipt of any financial assistance for thepurpose from Government or any other institution
|
: |
|
The above facts are true to the best of my knowledge andinformation.
|
| Place ......................... |
Name and signature of theapplicant
|
| Date ........................ |
|
| FORM XLV |
| (See rule 283) |
| APPLICATION FOR FAMILY PENSION |
| 1. Name and address of applicant |
: |
| 2. Address of the pensioner/worker |
: |
| 3. Relationship with worker |
: |
| 4. Date of death of the worker |
: |
| 5. Monthly pension received by the worker |
: |
|
6. Whether applicant is receiving pension from Government/Semi- Government or any other Institution? If yes, detailsthereof
|
: |
|
7. Whether applicant is receiving salary from Government/Semi-Government/private institutions? If yes, details thereof
|
: |
| 8. List of documents submitted |
: |
|
The above facts are true to the best of my knowledge andinformation.
|
|
| Place ......................... |
Name and signature of theapplicant
|
| Date ........................ |
|
LIST OF DOCUMENTS TO BE SUBMITTED ALONGWITH APPLICATION1. Death certificate of the worker.
2. Village Officer's Certificate showing relationship between the applicant and the worker.
3. Village Officer's Certificate stating that the applicant is not receiving any pension from Government/Semi-Government/Private Institution.
4. Village Officer's Certificate stating that the applicant is not receiving any salary from Government/Semi-Government/Private Institutions.
FORM XLVI(See rule 280)APPLICATION FOR EX GRATIA MEDICAL ASSISTANCE FOR ACCIDENTS
| 1. Name and address of applicant |
: |
| 2. Age and date of birth |
: |
| 3. Registration No. |
: |
|
4. Date of payment of first subscription,: amount, Challan No.and Name of Bank, Branch.
|
: |
|
5. Date of payment of last subscription Challan No., amount,name of Bank, branch
|
: |
| 6. Total amount of subscription |
: |
| 7. Details regarding accident |
: |
| 8. Nature of disability due to accident |
: |
|
9. Whether treated in Government hospital? If so, date ofadmission and date of discharge
|
: |
| 10. Whether applicant was in plaster? If so, for how many days |
: |
| 11. Details of documents submitted |
: |
| 12. Financial assistance applied for |
: |
|
13. Have you received any financial assistance for treatmentbefore? If yes, give particulars.
|
: |
|
The above facts are true to thebest of my knowledge and information.
|
| Place ......................... |
Name and signature of theapplicant
|
| Date ........................ |
|