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State of Tamilnadu - Section
Section 29 in Tamil Nadu Goldsmiths Social Security And Welfare Scheme, 2006
29. Construction of reference to the registration, contribution, etc., under the Tamil Nadu Manual Workers Social Security and Welfare Scheme, 2001.
- The contribution made by any manual worker and the contribution made by an employer after registration and the consequential benefits accrued to any manual worker under the Tamil Nadu Manual Workers Social Security and Welfare Scheme, 2001, shall be construed as contribution made and the benefits accrued under this Scheme.[Form I [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]][See clause 9(2)]Application For Registration| AffixPassportsizephotograph |
| 1 | Name of the worker | : | |
| 2 | Name of the Father/Husband | : | |
| 3 | Date of Birth | : | |
| (enclose Xerox Copy of evidence in proof dulyattested by a Group A or Group B officer)* | Day Month Year | ||
| 4 | Marital Status | : | |
| (Whether married, unmarried, widow/widower) | |||
| 5 | Permanent address | : | |
| 6 | Present address | : | |
| 7 | State whether self-employed or employed | : | |
| 8 | If employed, furnish the name and address of theestablished and also the Name and address of the employercontractor | : | |
| 9 | Nature of work | : | |
| 10 | Number of years engaged in the employment as onthe date of application | : | |
| 11 | Particulars of the member of the family | : |
| Sl. No. | Name | Age | Relationship | Marital Status |
| 1 | 2 | 3 | 4 | 5 |
| 12 | (a) Whether the wife/husband is employed?(b) If so furnish details | : | |
| 13 | Nomination for receipts of Natural Death/ Accidental Death Assistance | : |
| Name and address **of be the nominee/nominees | Nominee’s Relationship with the worker | Age of the nominee | Percentage of amount to be paid to eachnominee |
| 1 | 2 | 3 | 4 |
| Place:Date: | Signature and name of the person/Officerissuing the certificate |
| Place:Date: | Village Administrative Officer/RevenueInspector(for Chennai district) |
| Official Seal: | Labour Officer (Social Security Scheme)District with date:Name:Designation:] |
| Identity Card | LabourStatue |
| 1. Accident Insurance Scheme | Rs. | |
| (a) Accidental Death | 1,00,000 | |
| (b) Accidental Disability | Based on Extent of Disability | |
| 2. Natural death assistance | 15000 | |
| 3. Funeral expenses assistance | 2000 | |
| 4. Educational assistance: - | ||
| (a) Girl children studying 10th | 1000 | |
| (b) 10th Passed | 1000 | |
| (c) Girl children studying 10th | 1000 | |
| (d) Girl children studying 12th | 1500 | |
| (e) 12th Passed | 1500 | |
| (f) Regular Degree Course | 1500 | |
| With Hostel Facility | 1750 | |
| (g) Regular Post Graduate Course | 4000 | |
| With Hostel Facility | 5000 | |
| (h) Professional Degree Course | 4000 | |
| With Hostel Facility | 6000 | |
| (i) Professional PG Course | 6000 | |
| With Hostel Facility | 8000 | |
| (j) I.T.I. or Polytechnic course | 1000 | |
| With Hostel Facility | 1200 | |
| 5. Marriage Assistance | 2000 | |
| 6. Maternity Assistance | 6000 | |
| 7. Reimbursement of cost of spectacles | up to 500 | |
| 8. Pension | 1000 |
| AffixPassport SizePhotograph |
| Registration No. | |||
| Date | |||
| 1. Name | : | ||
| 2. Father/Husband | : | ||
| 3. Date of Birth/ Age | : | ||
| 4. Employment | : | ||
| Registration should be renewed before.......... | |||
| 5. Permanent Address | : | ||
| 6. Present Address | : | ||
| 7. Marital Status | : | ||
| 8. Details of Nominees | : | ||
| 9. Registration Number if member of Trade Union | : | ||
| Signature of the Worker | Signature of the Officer |
| Details of Scheme assistance provided to theworker | |||||
| Sl. No. | Name of the assistance provided | Name of the beneficiary | File No and Date | Amount distributed | Signature of the officer |