
 State of Tamilnadu- Act
-------------------------
 Tamil Nadu Pottery Workers Social Security and Welfare Scheme, 2006
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 TAMILNADU
   
 India
 
 Tamil Nadu Pottery Workers Social Security and Welfare Scheme, 2006
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 Rule TAMIL-NADU-POTTERY-WORKERS-SOCIAL-SECURITY-AND-WELFARE-SCHEME-2006 of 2006
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* Published on 1 September 2006
* Commenced on 1 September 2006
 Tamil Nadu Pottery Workers Social Security and Welfare Scheme, 2006
 
 Published vide Notification No. G.O. Ms. No. 88, L. and E., dated the 1st September, 2006 - No. II(2) /LE/453(e-14)/2006
 
 G.O. Ms. No. 88, L. and E., dated the 1st September, 2006 - No. II(2) /LE/453(e-14)/2006. - In exercise of the powers conferred by section 4 read with section 3 of the Tamil Nadu Manual Workers (Regulation of Employment and Conditions of Work) Act, 1982 (Tamil Nadu Act
 33 of 1982 
 ) and in supersession of the Labour and Employment Notification No. II(2) /LE/266(d-1)/2001, published at pages 1-17 of Part II - Section 2 of the Tamil Nadu Government Gazette Extraordinary dated the 28th February 2001, the Governor of Tamil Nadu hereby makes the following Scheme for the Scheduled employment under the said Act in item 43 :-
 
### 1. Short title, extent application and commencement.
(1) This Scheme may be called the Tamil Nadu Pottery Workers Social Security and Welfare Scheme, 2006.
 
(2) It extends to the whole of the State of Tamil Nadu.
 
(3) It shall apply to all manual workers engaged in pottery works.
 
(4) It shall come into force on the 1st September 2006.
 
### 2. Definitions.
 - In this Scheme, unless the context otherwise requires, -
 
(a) "Act" means the Tamil Nadu Manual Workers (Regulation of Employment and Conditions of Work) Act, 1982 (Tamil Nadu Act
 33 of 1982 
 );
 
(b) "Board" means the Tamil Nadu Pottery Workers Welfare Board established under section 6 of the Act;
 
(c) "dependent", in relation to a registered manual worker, means any of the relatives of such deceased workman as specified below :-
 
 (i) Wife or husband, as the case may be;
 
 (ii) Children;
 
 (iii) Widow and children of the pre-deceased son; and
 
 (iv) Parents;
 
(d) "family" means -
 
 (i) In the case of male member, his wife, children, whether married or unmarried, dependent parents and the widow and children of a deceased son of the member;
 
 (ii) In the case of a female member, her husband, children, dependent parents and the widow and children of a deceased son of the member;
 
(e) "Form" means the Form appended to this Scheme;
 
(f) "Fund" means the Tamil Nadu Pottery Workers Social Security and Welfare Fund established under the Scheme;
 
(g) "manual worker" means any person who has completed 18 years of age, but has not completed 60 years of age and who is engaged to do any manual work in the employment of pottery works specified in items 43 in the Schedule to the Act;
 
(h) "Secretary" means the Secretary of the Board appointed by the Government and includes any other officer put in charge of the Secretary;
 
(i) "self-employed person" means any person who has directly engaged himself in pottery works for his livelihood;
 
(j) words and expressions used in this scheme and not defined shall have the same meaning assigned to them in the Act.
 
### 3. Powers duties and functions of the Board.
(1) Subject to the other provisions of the Act, the Board may take such measures as it may consider necessary for implementing the Scheme.
 
(2) The Board shall -
 
(a) maintain and administer the "Tamil Nadu Pottery Workers Social Security and Welfare Fund" and collect the contributions towards that Fund;
 
(b) subject to the provisions of the Scheme, any property vested with the Board shall be held and utilised by it only for the purpose of the Scheme;
 
(c) have the authority to spend such sum, as it thinks fit for the purposes of the Scheme from out of the Fund;
 
(d) keep proper accounts for all receipts and expenses under the Scheme;
 
(e) submit annual budget to the Government for sanction;
 
(f) submit annual report to the Government on the working of the Scheme as laid down under sub-section (5) of section 8 of the Act;
 
(g) submit to the Government copies of all proceedings of the meetings of the Board;
 
(h) make all arrangements necessary for the annual audit of accounts of the Board in accordance with the instructions issued by the Government;
 
(i) furnish information to Government on such matters as the Government may refer to it, from time to time.
 
(3) The Board may -
 
(a) accept deposits from persons, authorities or establishments on such conditions as it deems fit;
 
(b) borrow money with the previous permission of the Government in order to augment the sources of funds;
 
(c) specify Forms, records, registers and statements, if so required, in addition to such of those Forms, records, registers and statements appended to this Scheme, for the administration of the Scheme and revise any of such Forms, records, registers and also specify, production of additional certificates, records along with such Forms, statement, etc.;
 
(d) make recommendations to the Government about modifications which are considered necessary in the Scheme.
 
### 4. Secretary of the Board.
(1) The Chief Executive Officer of the Board shall be the Secretary to the Board.
 
(2) The Secretary shall, with the approval of the Chairman of the Board, issue notices to convene meetings of the Board and keep the record of minutes and shall take necessary steps for carrying out the decisions of the Board.
 
### 5. Appointment of Chief Executive Officer and other officers and staff.
(1) The Government may appoint an officer of the Labour Department not below the rank of a Labour Officer as the Chief Executive Officer of the Board.
 
(2) The Government may appoint a Chief Accounts Officer in the cadre of Under Secretary, Finance Department or an Accounts Officer from the Treasuries and Accounts Department on foreign service terms and conditions.
 
(3) The Government may also appoint as many officers as may be necessary on deputation from the Labour Department or from any other departments or undertakings or Corporations or Boards of the State Government or by direct recruitment as Executive Officers for the purpose of implementation of the Scheme,
 
(4) The Government may also appoint as many Inspectors and staff as may be necessary on deputation from Labour Department or from any other departments or undertakings or Corporations or Boards of the State Government or by direct recruitment for the purpose of implementation of the Scheme.
 
### 6. Chief Executive Officer of the Board, etc., to be public servants.
 - The Chief Executive Officer and other officers and staff of the Board appointed under this Scheme shall be deemed to be public servants within the meaning of section 21 of the Indian Penal Code, 1860 (Central Act XLV of 1860).
 
### 7. Administrative and financial powers of the Chief Executive Officer.
(1) The Chief Executive Officer of the Board may, without reference to the Board, sanction expenditure on contingencies, services and purchase of articles subject to the limit up to which he may be authorised to sanction expenditure with such restrictions imposed by the Board with the approval of the Government.
 
(2) The Chief Executive Officer may also exercise such administrative and financial powers other than those specified in sub-clause (1) above, as may be delegated to him, from time to time, by the Board with the approval of the Government.
 
### 8. Opening of district and local offices.
 - The Board may, with the approval of the Government, open district and local offices as it may consider necessary for the purpose of implementing the Scheme. It may also define the functions of such offices.
 
### 9. Registration of manual workers.
(1) Any manual worker who has completed the age of 18 years, but not completed 60 years, may register his name with the Board [through the Labour Officer (Social Security Scheme) of the respective district]
 
 [Inserted by G.O. Ms. No. 122, dated 24.10.200S, published dated 31.10.2008.]
 
 to become a member of the Scheme.
 
(2) Application for such registration shall be made [in duplicate to the Labour Officer (Social Security Scheme) of the respective district]
 
 [Inserted by G.O. Ms. No. 122, dated 24.10.200S, published dated 31.10.2008.]
 
 in Form-I appended to this Scheme together with a certificate of employment issued by any of the persons or officers specified below :-
 
(a) Employer of any manual worker.
 
(b) President or the General Secretary of a registered trade union of the employment concerned or any other office bearer of the said trade union authorised by the said President or General Secretary in writing in this behalf.
 
(c) Any officer not below the rank of an Assistant Inspector of Labour in the Labour Department or an officer not below the rank of an Assistant Inspector of Factories in the Department of Inspectorate of Factories.
 
(d) [ Village Administrative Officer and for Chennai district, the Revenue Inspector concerned.]
 
 [Inserted by G.O. Ms. No. 122, dated 24.10.200S, published dated 31.10.2008.]
 
(3) (a) The registration of the name of the manual worker with the Board shall be made by the Labour Officer (Social Security Scheme) of the respective district after due verification by the respective Village Administrative Officer and for Chennai district, by the Revenue Inspector concerned.
 
[(b) The registration under this clause is valid for a period of [five years] or until the registered manual worker attains the age of sixty years, whichever is earlier.]
 
(4) Every registered manual worker whose name has been registered under this clause will be issued with an identity card in Form-II free of cost by the [Labour Officer (Social Security Scheme) of the respective district]
 
 [Substituted for 'Board or district or local office' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 .
 
(5) In case of loss of the identity card, a duplicate identity card will be issued by the Board or district or local office on an application made by the registered manual worker concerned and on payment of twenty rupees.
 
(6) (a) 
 Every registered manual worker shall furnish name, address, relationship of the nominee to whom the benefits shall be payable in the event of his death in the application.
 
(b) If a manual worker has a family at the time of making a nomination, the nomination shall be made in favour of one or more members of his family. Any nomination made by such employee in favour of a person who is not a member, of his family shall be void.
 
(c) If at the time of making a nomination, the manual worker has no family, the nomination may be made in favour of any person or persons, -
 
 (i) if the manual worker subsequently acquires a family, such nomination shall forthwith become invalid and the manual worker shall make within ninety days of acquiring a family, a fresh nomination in favour of one or more members of his family.
 
 (ii) if a nominee predeceases the manual worker, the interest of the nominee shall revert to the manual worker who shall make a fresh nomination in respect of such interest.
 
(d) [ Where the nomination made is incomplete or becomes void, the assistance shall be released to the legal heirs of the deceased registered manual worker.]
 
 [Inserted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
### 10. Suspension and cancellation of membership.
(1) The [Labour Officer (Social Security Scheme) of the respective district]
 
 [Substituted for 'Executive Officer' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 may, if he has any reasonable cause to believe that the membership and or benefit under this scheme has been secured by a registered manual worker by making any statement in relation to any application or the registration, which is incorrect or false in any material particular or has contravened any of the provisions of the Act, or any rule or scheme framed under the Act, suspend such membership pending the completion of any enquiry against the holder of such membership.
 
(2) The Executive Officer may, if he is satisfied, after making such inquiry as he may think fit, that the holder of a membership has made a false or incorrect statement of the nature referred to in sub-clause (1), or has contravened any provision of the Act or any rule or scheme framed under the Act, cancel such membership:
 
 Provided that no such membership shall be cancelled unless the holder thereof has been given a reasonable opportunity of showing cause against the proposed action.
 
(3) Every person whose membership has been cancelled shall forfeit all his claims under the Scheme.
 
(4) Any registered manual worker aggrieved by the orders passed by the authority referred to in sub-clause (2) is entitled to prefer an appeal to the Chief Executive Officer within thirty days from the date of receipt of such orders. The Chief Executive Officer may, for valid reasons to be recorded in writing, allow preference of appeal after a period of 30 days, but not exceeding ninety days. On such preference of appeal, the Chief Executive Officer shall dispose of the appeal within a period of three months from the date of filing of such appeal, after giving an opportunity to the aggrieved manual worker. The orders passed by the Chief Executive Officer shall be final.
 
### 11. Maintenance of registers.
(1) Every employer shall maintain a Register of Contribution in Form-III.
 
(2) Every employer shall maintain an Inspection Register in which the Inspector appointed for the purpose of the Scheme may record his remarks regarding any defects that may come to light at the time of his inspections.
 
(3) The records relating to a calendar year shall be preserved until the end of the subsequent three years.
 
(4) The Board [and the Labour Officer (Social Security Scheme) of the respective district]
 
 [Inserted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 shall maintain a Register of Members in Form-IV.
 
### 12. The Tamil Nadu Pottery Workers Social Security and Welfare Fund.
(1) There shall be constituted a fund called, "The Tamil Nadu Pottery Workers Social Security and Welfare Fund" to which shall be credited,-
 
(a) all contributions received by the Board from the Government as grant;
 
(b) all contributions received by the Board under the Scheme;
 
(c) all moneys received by the Board by way of sale or disposal of properties and other assets;
 
(d) interest on investments in securities and deposits and rents;
 
(e) all moneys received by way of interest charged for the delayed payment of contribution under clause 27 of the Scheme; and
 
(f) all moneys received by the Board in any other manner or from any other source.
 
(2) All moneys received by the Board and forming part of the Fund shall be kept in Current Account of any of the Nationalised Banks or any of the Co-operative Banks under the control and supervision of Tamil Nadu State Co-operative Bank or any other Bank as may be specified by the Board, from time to time. Such account shall be jointly operated by the Secretary of the Board and another officer authorised by the Secretary of the Board.
 
### 13. Contributions.
(1) The contribution payable under this Scheme shall comprise the contribution payable to the Board by an employer (hereinafter referred to as the "employer's contribution"), and the grant made to the Board by the Government, from time to time, as contribution to the Fund which shall form part of the Fund.
 
(2) All remittances payable to the Fund shall be rounded off to the nearest rupee.
 
(3) Every employer shall pay to the Board a sum equivalent to 3 percent of the wages payable by him to the manual workers employed by him, before the 15th day of every month by means of a Demand Draft drawn in favour of the "Secretary, Tamil Nadu Pottery Workers Welfare Board", payable at Chennai accompanied by a statement in Form V.
 
### 14. Renewal of registration.
(1) Every manual worker whose name has been registered under clause 9 shall renew his registration before the expiry of the period of [five years]
 
 [Substituted for 'two years' by Notification No. II(2) /PUHR/687(g-13)/2014 vide G.O. Ms. No. 134, dated 18.11.2014, published dated 18.11.2014.]
 
 specified in that clause.
 
(2) A registered manual worker who fails to renew his registration shall cease to be member automatically. No specific orders on the cessation of membership need be issued under this provision.
 
(3) A registered manual worker whose membership ceased under sub-clause (2) may be re-admitted by the [Labour Officer (Social Security Scheme) of the respective district, after due verification]
 
 [Substituted for 'Executive Officer or any other officer authorized in this behalf by the Board' by G.O. Ms. No. 122, dated 24.10.2008. published dated 31.10.2008.]
 
 .
 
(4) Notwithstanding his re-admission under sub-clause (3), he shall not be eligible to claim any benefits that may become due during the period of non renewal.
 
### 15. Intimation about change of employer, employment, place, etc.
 - Every registered manual worker who leaves or changes his service under an employer, or changes his scheduled employment to another, or migrates from one place to another place shall, within thirty days of such change intimate the [Labour Officer (Social Security Scheme) of the respective district]
 
 [Substituted for 'Chief Executive Officer or any other officer authorized by the Chief Executive Officer in this behalf' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 by a letter sent by registered post or delivered in person.
 
### 16. Utilisation of Fund.
(1) The Fund of the Scheme shall vest in, and be held and applied by, the Board as Trustees, subject to the provisions and for the purposes of this Scheme.
 
(2) It shall be lawful for the Board to invest the moneys in any Government Financial Institutions, Co-operative Banks, Nationalised Banks, or Corporations authorized by the Government which offers the highest rate of interest as on the date of such investment.
 
### 17. Personal Accident Relief.
(1) All registered manual workers when met with the accident are eligible for Personal Accident Relief [and where the accident results in death, their nominees are eligible for Personal Accident Relief.]
 
 [Inserted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 Explanation. - For the purpose of this clause, "accident" means any bodily injury [\*\*\*]
 
 [Words 'or death' omitted by Notification No. II(2) /LE/90(m-30)/2011 vide G.O. Ms. No. 37, dated 28.02.2011, published dated 01.03.2011.]
 
 or loss of limbs or loss of sight resulting solely and directly from accident arising out of and in the course of his employment [or death]
 
 [Inserted by Notification No. II(2) /LE/90(m-30)/2011 vide G.O. Ms. No. 37, dated 28.02.2011, published dated 01.03.2011.]
 
 but does not include any intentional self injury, suicide, attempted suicide, injury caused while under the influence of intoxicating liquor or drugs or resulting from the injured worker committing any breach of the law or rules, regulations or instructions applicable, from time to time.
 
(2) The risk covered by the scheme and the amount of compensation payable shall be as follows : -
 
|  |  |  |
| --- | --- | --- |
| 
 (a)  Death
  | 
 | 
 Rs. 1,00,000
  |
| 
 (b)  Loss of actual physical separation of or
 
 total and irrecoverable loss of use of-
  | 
 | 
 |
| 
 (i)  both hands; or
  | 
 | 
 Rs. 1,00,000
  |
| 
 (ii)  both feet; or
  | 
 | 
 |
| 
 (iii)  one hand and one foot; or
  | 
 | 
 |
| 
 (iv)  total and irrecoverable loss of sight in both eyes,
  | 
 | 
 |
| 
 (c)  Loss of actual physical separation of or total and
 
 irrecoverable loss of use of -
 
 (i)  one hand; or
  | 
 | 
 Rs. 50,000
  |
| 
 (ii)  one foot; or
  | 
 | 
 |
| 
 (iii)  total and irrecoverable loss of sight in one eye.
  | 
 | 
 |
| 
 (d)  Permanent total disablement from injuries
 
 other than those specified in items (b)  and (c) above.
  | 
 | 
 Rs. 25,000
  |
| 
 (e)  Permanent partial disablement as specified
 
 in column (1)  of the Table appended hereunder.
  | 
 | 
 At the rate specified in the corresponding entry
 
 in column (2)  of the Table below:
  |
 Table
 
|  |  |
| --- | --- |
| 
 Nature of disablement
  | 
 Compensation in percentage (to be applied on
 
 Rs. 1,00,000)
  |
| 
 1
  | 
 | 
 2
  |
| 
 | 
 | 
 Percent
  | 
 |
| 
 1
  | 
 Loss of toes
  | 
 All
  | 
 20
  |
| 
 | 
 | 
 Great both phalanges
  | 
 5
  |
| 
 | 
 | 
 Great One phalanx
  | 
 2
  |
| 
 | 
 | 
 Other than great
  | 
 1
  |
| 
 | 
 | 
 if more than one toe lost each
  | 
 1
  |
| 
 2
  | 
 Loss of hearing
  | 
 Both ears
  | 
 50
  |
| 
 3
  | 
 Loss of hearing
  | 
 one ear
  | 
 15
  |
| 
 4
  | 
 Loss of four fingers and thumb of one hand
  | 
 | 
 40
  |
| 
 5
  | 
 Loss of four fingers
  | 
 | 
 35
  |
| 
 6
  | 
 Loss of thumb
  | 
 Both Phalanges
  | 
 25
  |
| 
 7
  | 
 Loss of index finger
  | 
 Three Phalanges
  | 
 10
  |
| 
 | 
 | 
 Two Phalanges
  | 
 8
  |
| 
 | 
 | 
 One Phalanx
  | 
 4
  |
| 
 8
  | 
 Loss of middle linger
  | 
 Three Phalanges
  | 
 6
  |
| 
 | 
 | 
 Two Phalanges
  | 
 4
  |
| 
 | 
 | 
 One Phalanx
  | 
 2
  |
| 
 9
  | 
 Loss of ring finger
  | 
 Three Phalanges
  | 
 5
  |
| 
 | 
 | 
 Two Phalanges
  | 
 4
  |
| 
 | 
 | 
 One Phalanx
  | 
 2
  |
| 
 10
  | 
 Loss of little finger
  | 
 Three Phalanges
  | 
 4
  |
| 
 | 
 | 
 Two Phalanges
  | 
 3
  |
| 
 | 
 | 
 One Phalanx
  | 
 2
  |
| 
 11
  | 
 Loss of Metacarpal 1st or 2nd 3rd, 4th or 5th
  | 
 (Additional) | 
 3
  |
| 
 | 
 | 
 (Additional) | 
 2
  |
| 
 12
  | 
 Any other permanent partial disablement
  | 
 Percentage as assessed by the Doctor.
  | 
 |
 (2-A) In case of disablement due to accident, the registered manual worker shall also be eligible to claim wheel chair or artificial limbs, in addition to the amount of compensation.]
 
 [Inserted vide G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
(3) Claim. - (a) Immediately upon the happening of any accident while in pursuit of his employment resulting in death or loss of limbs or loss of sight, the employer shall send a report to the [Labour Officer (Social Security Scheme) of the respective district]
 
 [Substituted for 'Board' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 and to the Police in Form VI, within three days of such occurrence of the accident. In any other case, the report of the accident may be sent to the Board either by the injured worker or the nominee of the deceased worker or a representative of a trade union of the employment concerned. The Board shall investigate the accident occurred in the work place either on the report of the accident received from the employer or the injured worker or the nominee of the deceased worker or a representative of a trade union of the employment concerned.
 
(b) In the case of injury or loss of limbs or loss of eyesight specified in items (b) to (e) of sub-clause (3), the claim shall be made by the registered manual workers concerned, in the event of death of a registered manual workers, the claim shall be made by his nominee in Form-VII.
 
(c) In case of death of a registered manual worker due to accident, death certificate and post-mortem certificate issued by an authority who is competent to issue such certificate shall be produced by the claimant. If there is delay for more than thirty days in getting the post-mortem certificate, the certificate given by the Tahsildar in this regard shall be produced.
 
(d) In case of loss of limbs or loss of eyesight or, partial disablement due to accident, the claimant should produce a medical certificate issued by a medical officer not below the rank of a Civil Assistant Surgeon.
 
(e) The [Labour Officer (Social Security Scheme) of the respective district]
 
 [Substituted for 'Board or any Officer authorised in this behalf' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 shall, after due verification, [sanction the compensation in addition to provide artificial limbs or wheel chair to the claimant]
 
 [Substituted for 'sanction the compensation to the claimant' vide G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
 .
 
### 18. Pension scheme.
 - [(1)  Eligibility. - Every registered manual worker who has complete 60 years of age is eligible for pension:
 
 Provided that a manual worker who has not completed 60 years of age, but registered with the Board is also eligible for pension, if he has become disabled due to sickness and incapacitated from normal work;]
 
 [Substituted by Notification No. II(2) /LE/90(m-15)/2011 vide G.O. Ms. No. 36, dated 28.02.2011, published dated 01.03.2011.]
 
(2) Claim. - (a) Every registered manual worker who is eligible for pension under sub-clause (1) shall apply to the [Labour Officer (Social Security Scheme) of the respective district]
 
 [Substituted for 'Board' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 in Form VIII and VIII-A as applicable:
 
 Provided that a disabled manual worker who is eligible for pension under the proviso to sub-clause (1)  shall produce to the Board a certificate of proof of his disability issued by a Medical Officer not below the rank of a Civil Surgeon.
 
(b) The Board shall examine every application for pension in accordance with the provisions of this clause and may accept or reject the claim. Hie decision of the Board shall be final:
 
 Provided that the Board shall, before rejecting a claim for pension, give the applicant a reasonable opportunity of making his representation.
 
(3) Amount of pension. - The quantum of pension shall be [Rs. 1000 (Rupees One Thousand only)]
 
 [Substituted for 'Rs. 500 (Rupees five hundred only)' by G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
 .
 
### 19. Assistance to meet the funeral expenses of a registered manual worker.
(1) If a registered manual worker dies, the [Labour Officer (Social Security Scheme) of the respective district, after due verification]
 
 [Substituted for 'Secretary or any other officer authorised in this behalf by the Board' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 , shall sanction a sum of Rs. 2,000 (Rupees two thousand only) to the nominee of the deceased registered manual worker to meet the funeral expenses of the deceased registered manual worker.
 
(2) The application for claiming the amount specified in sub-clause (1) shall be in Form IX and shall be accompanied by the death certificate of the deceased registered manual worker and the original identity card issued [\*\*\*]
 
 [Words 'by the Board' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 to the deceased worker.
 
### 20. Assistance on the natural death of a registered manual worker.
(1) If registered manual worker dies naturally, the [Labour Officer (Social Security Scheme) of the respective district, after due verification]
 
 [Substituted for 'Secretary or any other officer, authorized in this behalf by the Board' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 , shall pay a sum of Rs. 15,000 (Rupees fifteen thousand only) to the nominee of the deceased registered manual worker.
 
(2) The application for claiming the amount specified in sub-clause (1) shall be in Form-IX and shall be accompanied by the death certificate of the deceased registered manual worker and the original identity card issued to the deceased worker.
 
### 21. Assistance for education of the son or daughter of a registered manual worker.
 - [(1)  The assistance for the education of the children of a registered manual worker shall be sanctioned by the Labour Officer (Social Security Scheme) of the respective district, after due verification, as specified in the Table below : -]
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 [The Table]
 
 [Substituted vide G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
|  |  |  |  |  |
| --- | --- | --- | --- | --- |
| 
 Sl. No.
  | 
 Form
  | 
 Course of study
  | 
 Day scholar
  | 
 Hosteller
  |
| 
 | 
 | 
 | 
 Boys
  | 
 Girls
  | 
 Boys
  | 
 Girls
  |
| 
 | 
 | 
 | 
 Rs.
  | 
 Rs.
  | 
 Rs.
  | 
 Rs.
  |
| 
 1
  | 
 XI
  | 
 10th Std. studying - Girl children only
  | 
 -
  | 
 1000
  | 
 -
  | 
 -
  |
| 
 2
  | 
 X
  | 
 10th Std. passed
  | 
 1000
  | 
 1000
  | 
 -
  | 
 -
  |
| 
 3
  | 
 XI
  | 
 11th Std. studying - Girl children only
  | 
 -
  | 
 1000
  | 
 -
  | 
 -
  |
| 
 4
  | 
 XI
  | 
 12th Std. studying - Girl children only
  | 
 -
  | 
 1500
  | 
 -
  | 
 -
  |
| 
 5
  | 
 X
  | 
 12th Std. passed
  | 
 1500
  | 
 1500
  | 
 -
  | 
 -
  |
| 
 6
  | 
 XII
  | 
 Studying regular Bachelor Degree course (Every
 
 academic year)
  | 
 1500
  | 
 1500
  | 
 1750
  | 
 1750
  |
| 
 7
  | 
 XII
  | 
 Studying regular Post Graduate course (Every
 
 academic year)
  | 
 4000
  | 
 4000
  | 
 5000
  | 
 5000
  |
| 
 8
  | 
 XII
  | 
 Studying regular Professional Course in Law,
 
 Engineering, Medicine, Veterinary Science and allied courses
 
 (Every academic year)
  | 
 4000
  | 
 4000
  | 
 6000
  | 
 6000
  |
| 
 9
  | 
 XII
  | 
 Studying regular Post Graduate Professional
 
 Course in Law, Engineering, Medicine, Veterinary Science and
 
 allied courses (Every academic year)
  | 
 6000
  | 
 6000
  | 
 8000
  | 
 8000
  |
| 
 10
  | 
 XII
  | 
 Studying ITI or Polytechnic course (Every
 
 academic year)
  | 
 1000
  | 
 1000
  | 
 1200
  | 
 1200
  |
(2) The amount shall be sanctioned only if the following conditions are fulfilled, namely : -
 
(a) only two children of a registered manual worker shall be given this assistance; and
 
(b) the registered manual worker shall have no dues payable to the Board.
 
(3) [ The application for assistances specified in serial numbers 2 and 5 in column (1) of the Table in sub-clause (1) shall be in Form X to be submitted after passing of the course, the application for assistances specified in serial numbers 6 to 10 in column (1) of the said Table shall be in Form XII to be submitted before completion end passing of the course and the application for assistances specified in serial numbers 1, 3 and 4 shall be in Form XI to be submitted before completion and passing of the course.]
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
(4) Where both husband and wife have applied for assistance under this clause, one of them alone shall be eligible for such assistance.
 
### 22. Assistance for Marriage.
(1) The [Labour Officer (Social Security Scheme) of the respective district shall, on an application from a registered manual worker, after due verification]
 
 [Substituted for 'Secretary or any other Officer authorised in this behalf by the Board, shall on an application from a registered manual worker' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 , sanction a sum of [Rs.3000/- (Rupees three thousand only) for men and Rs.5000/- (Rupees five thousand only) for women, as assistance to meet the marriage expenses of the registered manual worker or of the son or daughter of the registered manual worker, as the case may be]
 
 [Substituted for 'Rs. 2,000 (Rupees two thousand only) as assistance to meet the marriage expenses of the applicant or his son or daughter' by G.O. Ms. No. 39, dated 28.02.2011, published dated 1.3.2011.]
 
 .
 
(2) The amount shall be sanctioned only if the following conditions are fulfilled, namely :-
 
(a) the family of a registered manual worker can avail this assistance only twice;
 
(b) the registered manual worker shall have no dues payable to the Board;
 
(c) the registered manual worker shall have attained the age prescribed by law for marriage; and
 
(d) the person for whose marriage the assistance is sought shall have attained the age prescribed by law for marriage.
 
(3) Where both husband and wife have applied for assistance to the marriage of his son or daughter under this clause, one of them alone shall be eligible for this assistance.
 
(4) The application for assistance under this clause shall be in Form-XIII.
 
### 23. Assistance for delivery or the miscarriage of pregnancy or the termination of pregnancy by registered female manual worker.
 - [(1)  The Labour Officer (Social Security Scheme) of the respective district shall, on an application from a registered female manual worker, sanction the assistance as indicated below, after due verification of the proof produced by her of her pregnancy or delivery of child by her or the miscarriage of her pregnancy or the termination of pregnancy : -
 
|  |  |  |
| --- | --- | --- |
| 
 (i)  Pregnancy
  | 
 | 
 - Rs.6,000/-
  |
| 
 | 
 | 
 (Rs.3,000/- shall be paid on the seventh month
 
 of pregnancy and remaining Rs.3,000/- shall be paid on delivery
 
 of the child)
  |
| 
 (ii)  Miscarriage of pregnancy
  | 
 | 
 -Rs.3,000/-
  |
| 
 (iii)  Termination of pregnancy
  | 
 | 
 -Rs.3,000/-.]
  |
(2) The amount shall be sanctioned, only if the following conditions are fulfilled, namely : -
 
(a) registered female manual worker can get this assistance only twice;
 
(b) registered female manual worker shall have no dues payable to the Board;and
 
(c) registered female manual worker shall not be given this assistance if she already has two children.
 
(3) The application for claiming the amount specified in sub-clause (1) shall be in Form-XIV
 
### 24. Assistance for purchase of spectacles by a registered manual worker.
(1) The [Labour Officer (Social Security Scheme) of the respective district, shall on an application Form XV from a registered manual worker, after due verification]
 
 [Substituted for 'Secretary or any other officer authorised in this behalf by the Board, shall on an application in Form XV from a registered manual worker' by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 , sanction a sum not exceeding Rs. 500 (Rupees five hundred only) as an assistance towards reimbursement of cost of spectacles.
 
(2) [ \*\*\*]
 
 [Sub-para (2)  omitted vide GO Ms. No. 90, dated 2.6.2015, published dated 1.7.2015.]
 
(3) The amount shall be sanctioned only if the following conditions are fulfilled, namely :-
 
(a) This assistance shall be given to a registered manual worker only once.
 
(b) The registered manual worker applying for assistance shall have no dues payable to the Board.
 
### 25. Eligibility to avail the benefits.
 - A registered manual worker will be eligible to avail the benefits under this Scheme only if he has not availed similar benefits of any other Schemes of the Government.
 
### 26. Penalty.
(1) If any employer who, for the purpose of avoiding any payment to be made by him under this Act or under the scheme or if any person who, for the purpose of enabling an employer to avoid such payment, knowingly makes or causes to be made any false statement or false representation shall be punishable with fine which may extend to five hundred rupees or with imprisonment for such term which shall not exceed three months and for the second or subsequent offence with fine which may extend to one thousand rupees or with imprisonment which shall not exceed a term of six months.
 
(2) If an employer who contravenes or makes default in complying with any of the provisions of this Scheme shall, for such contravention or non-compliance, be punishable with fine which may extend to five hundred rupees or with imprisonment for such term which shall not exceed three months and for the second or subsequent offence, with fine which may extend to one thousand rupees or with imprisonment which [shall not exceed a term of six months or with both imprisonment and fine and if the contravention is continued after conviction, with a further fine which may extend to one hundred rupees for each day on which the contravention is so continued]
 
 [Substituted for 'shall not exceed a term of six months' by Notification No. II(2) /LE/658/2015 vide GO Ms. No. 168, dated 9.10.2015, published dated 4.11.2015.]
 
 .
 
### 27. Mode of recovery of amount from employers.
 - Any amount due from the employer in pursuance of the scheme shall, without prejudice to any other mode of recovery, be recoverable on behalf of the Board as an arrear of land revenue together with interest at such rate as may be notified by the Government.
 
### 28. Power to remove difficulties.
 - If, in the opinion of the Board, any difficulty or doubt arises as to the interpretation of any of the provisions of the Scheme or in the implementation of the Scheme, the Board shall refer the question to the Government and the decision of the Government shall be final and binding.
 
### 29. Construction of reference to the registration, contribution, etc., under the Tamil Nadu Manual Workers Social Security a 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
  |
 To
 
 The Labour Officer (Social Security Scheme),
 
 .................district.
 
 Registration No. ................
 
 (to be filled in by the Registration Authority)
 
|  |  |  |  |
| --- | --- | --- | --- |
| 
 1
  | 
 Name of the worker
  | 
 | 
 :
  |
| 
 2
  | 
 Name of the Father/Husband
  | 
 | 
 :
  |
| 
 3
  | 
 Date of Birth
  | 
 | 
 :
  |
| 
 | 
 (enclose Xerox Copy of evidence in proof duly
 
 attested 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 the
 
 established and also the Name and address of the employer
 
 contractor
  | 
 | 
 :
  |
| 
 9
  | 
 Nature of work
  | 
 | 
 :
  |
| 
 10
  | 
 Number of years engaged in the employment as on
 
 the 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 NaturalDeath/ AccidentalDeath 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 each
 
 nominee
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  |
 \*(i)  Birth Certificate or (ii) School Certificate or (iii) Driving License or (iv) Ration Card or (v) Voter's identity card or(vi) Certificate from Registered Medical Practitioner not below the rank of Civil Surgeon of a Government Hospital in the prescribed format duly signed by the worker.
 
 \*\*Any false declaration/certification will entail legal action.
 
 \*\*Nominees shall be Dependant Family Members.
 
 Signature/Thumb impression of the manual worker
 
 (Left hand thumb impression to be attested by the Registering Authority)
 
 Declaration by the Applicant\*\*\*
 
 In declare that I am not registered as a member in any other Manual workers welfare board or Boards constituted by the Government of Tamil Nadu or under any other Government scheme.
 
 Signature or left hand thumb impressionof the manual worker.(Left hand thumb impression to be attestedby the Registration authority)
 
 Certificate of Employment\*\*\*
 
 Certified that the particulars furnished by Thiru/Thirumathi/Selvi\_\_\_\_\_\_\_\_\_\_\_\_\_regarding employment as a manual worker in the application for registration are true to the best of my knowledge and belief.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature and name of the person/Officer
 
 issuing the certificate
  |
 \*\*\*Any false declaration/certification will entail legal action
 
 Verification Certificate
 
 After due verification it is certified that the application and the proof are found to be correct and recommended for registration.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Village Administrative Officer/Revenue
 
 Inspector(for Chennai district)
  |
 Office Note :-
 
 Application and proof verified. The recommendation of the............... is accepted and the applicant is registered as member of the Tamil Nadu............... Welfare Board.
 
 Application for membership rejected (In case of rejection, reason should be clearly mentioned).
 
 Labour Officer (Social Security Scheme)...........District
 
 Acknowledgement Slip
 
 Received from Selvi/Thiru/Tmt.......... residing at................. application for registration as manual worker in the Tamil Nadu ............Welfare Board.
 
|  |  |
| --- | --- |
| 
 Official Seal:
  | 
 Labour Officer (Social Security Scheme)District with date:Name:Designation:
  |
 Form II
 
 [See clause 9(4) ]
 
 Identity Card
 
 Tamil Nadu............Welfare Board
 
|  |  |  |
| --- | --- | --- |
| 
 | 
 Identity Card
  | 
 LabourStatue
  |
 Scheme Assistances of the Board
 
|  |  |  |
| --- | --- | --- |
| 
 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
  |
 Tamil Nadu............Welfare Board
 
|  |  |  |
| --- | --- | --- |
| 
 | 
 | 
 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 the
 
 worker
  |
| 
 Sl. No.
  | 
 Name of the assistance provided
  | 
 Name of the beneficiary
  | 
 File No and Date
  | 
 Amount distributed
  | 
 Signature of the officer
  |
| 
 | 
 | 
 | 
 | 
 | 
 |
 General Instructions
 
 • The Registering individual should have completed 18 years of age and below 60 years of age.
 
 • No Registration/Renewal Fee.
 
 • Registration should be renewed once in two years.
 
 • In case of loss of Identity Card, Duplicate Identity Card may be collected from the Assistant Inspector of Labour by remitting Rs. 20.
 
 • In case of change of residence, new address should be intimated to the Board.
 
 • After marriage of the worker, application should be made to the Board for change of nominee in the original registration application form.
 
 • In the event of death of the worker, the original Identity Card should be surrendered to the Board along with the application for natural death assistance.
 
 • The original Identity Card should be enclosed along with the Claim application each time when the assistance is sought for.
 
 UZHAIPPOM
 
 UYARVOM
 
### 8. , Valluvar Kottam High Road, Nungambakkam Chennai - 600034 Phone: 2823 2129
 
 Form - III
 
 [See clause 11(1) ]
 
### 1. Name and address of the Employer ###
 2. Name of the Establishment
|  |
| --- |
| 
 Register of contribution
  |
| 
 Name of the worker
  | 
 Registration No.
  | 
 Nature of employment
  | 
 Wages earned during the month
  | 
 Total wages
  | 
 Employers Contribution made to the Board
  | 
 Particulars of D.D. (No., date and name of the
 
 Bank)
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  | 
 6
  | 
 7
  |
| 
 | 
 | 
 | 
 | 
 | 
 | 
 |
| 
 | 
 | 
 | 
 | 
 | 
 | 
 |
| 
 | 
 | 
 | 
 | 
 | 
 | 
 |
| 
 | 
 | 
 | 
 | 
 | 
 | 
 |
| 
 | 
 | 
 | 
 | 
 | 
 | 
 |
 Form - IV
 
 [See clause 11(4) ]
 
 Membership Register
 
|  |  |  |  |  |
| --- | --- | --- | --- | --- |
| 
 Serial Number
  | 
 Name of the Manual Worker
  | 
 Name and address of the establishment (in case
 
 of self employed worker, indicate the same)
  | 
 Date of Registration
  | 
 Registration Number
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  |
| 
 | 
 | 
 | 
 | 
 |
 Form - V
 
 [See clause 13(3) ]
 
### 1. Name and address ###
 2. Name of the Establishment
 Statement of Contribution
 
|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 
 Sl. No.
  | 
 Name of the worker
  | 
 Registration No.
  | 
 Nature of employment
  | 
 Wages earned during the month
  | 
 Total Wages
  | 
 Employers Contribution made to the Board
  | 
 Particulars of D.D. (No., Date and Name of the
 
 Bank)
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  | 
 6
  | 
 7
  | 
 8
  |
| 
 | 
 | 
 | 
 | 
 | 
 | 
 | 
 |
 Form - VI
 
 [See clause 17(3) (a)]
 
 Accident Intimation Form
 
 To
 
 The Secretary,
 
 ....................................
 
 ....................................
 
 To
 
 The Inspector/ Sub-Inspector of Police
 
 .....................................
 
 Sir,
 
 Thiru/Thirumathi/Selvi/Selvan.............son of/wife of/daughter of........... employed in the work place.........at.........has suffered loss of limbs/loss of eye-sight/total disablement/partial injury/[death due to accident occurred on the\_\_\_\_\_\_\_\_\_\_\_\_\_(date)  at\_\_\_\_\_\_\_(time)]
 
 [Substituted for 'death due to accident' by Notification No. II(2) /LE/657/2015 vide G.O. Ms. No. 168, dated 9.10.2015, published dated 4.11.2015.]
 
 .
 
 (Signature of the Employer)
 
|  |  |
| --- | --- |
| 
 Address:................................................................Date:
  | 
 Signature of the worker/Nominee/Representative of
 
 a Trade Union.
  |
 [Form - VII
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See clause 17(3) (b)]
 
 Application For Payment of Compensation For [accidental Death/disability/provision of Artificial Limbs or Wheel Chair]
 
 [Substituted for 'Accidental Death/disability' vide G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
 To
 
 The Labour Officer (Social Security Scheme),
 
 .............district.
 
|  |  |  |  |
| --- | --- | --- | --- |
| 
 1
  | 
 (a)  Name of the registered manual worker
  | 
 | 
 :
  |
| 
 | 
 (b)  Address(in full)
  | 
 | 
 :
  |
| 
 | 
 (on the date of death/disability)
  | 
 | 
 :
  |
| 
 | 
 (c)  Age
  | 
 | 
 :
  |
| 
 | 
 (d)  Registration number and date of initial
 
 registration
  | 
 | 
 :
  |
| 
 | 
 (e)  Renewal date
  | 
 | 
 :
  |
| 
 | 
 (f)  Occupation
  | 
 | 
 :
  |
| 
 2
  | 
 (a)  Area
  | 
 | 
 :
  |
| 
 | 
 (b)  Place
  | 
 | 
 :
  |
| 
 | 
 (c)  District
  | 
 | 
 :
  |
| 
 3
  | 
 (a)  Name of the nominee
  | 
 | 
 :
  |
| 
 | 
 (b)  Relationship with the deceased registered
 
 manual worker(in the case of accidental death only)
  | 
 | 
 :
  |
| 
 | 
 (c)  Age of the nominee
  | 
 | 
 :
  |
| 
 4
  | 
 Whether the claimant is the registered worker?
 
 himself (in the case of accidental disability) or the nominee of
 
 the registered manual worker
  | 
 | 
 :
  |
| 
 5
  | 
 Date and time of accident
  | 
 | 
 :
  |
| 
 6
  | 
 Place of accident
  | 
 | 
 :
  |
| 
 | 
 (a)  at the work place
  | 
 | 
 :
  |
| 
 | 
 (b)  outside the work place
  | 
 | 
 :
  |
| 
 7
  | 
 Whether intimation regarding accident has been
 
 given in Form VI as per clause 17(3) (a)?
  | 
 | 
 :
  |
| 
 8
  | 
 Whether the accident resulted in death/ loss of
 
 limb/loss of eye sight/partial injury?
  | 
 | 
 :
  |
| 
 9
  | 
 In the case of accidental disability, a
 
 certificate from a Civil Surgeon of the Government Hospital
 
 indicating tire percentage of disability due to accident with
 
 details should be obtained and enclosed in original.
  | 
 | 
 :
  |
| 
 [9-A
 
 [Inserted vide G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
 | 
 In case of accidental disability, whether the
 
 applicant requires wheel chair/artificial limbs (strike out
 
 whichever is not applicable)]
  | 
 | 
 |
| 
 10
  | 
 (i)  Date and time of death(in case of accidental
 
 death)
  | 
 | 
 :
  |
| 
 | 
 (ii)  Attested copy of First Information Report
 
 from the Police Station nearer to the place of accident to be
 
 closed
  | 
 | 
 :
  |
| 
 | 
 (iii)  Post-Mortem Certificate and final
 
 Investigation Report should be sent in original
  | 
 | 
 :
  |
| 
 | 
 (iv)  Death Certificate (attested copy) should be
 
 enclosed
  | 
 | 
 :
  |
 Signature /Thumb impression of theregistered manual worker/Nominee in case of death.
 
 Declaration by the Claimant
 
 I hereby declare that the particulars furnished above are correct and true to the best of my knowledge. In the event of any of the information given above is ultimately found to be false, [I hereby agree to refund the full amount of compensation and/or value of artificial limbs or wheel chair received.]
 
 [Substituted for 'I hereby agree to refund in full the amount received as assistance for accidental death/disability' vide G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
 I also hereby declare that I have not received similar benefit by claim in any other Welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government schemes.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature/Thumb impression of theRegistered
 
 Manual Worker/Nominee in case of death.
  |
 \*\*Any false declaration/certification will entail legal action.
 
 Sanction
 
 I hereby sanction after due verification for the immediate payment of Rs......... /- (Rupees............. only) towards [accidental death/disability/provision of artificial limbs or wheel chair]
 
 [Substituted for 'accidental death/disability' vide G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
 to Selvi/Thiru/Tmt................ nominee of the deceased worker/registered worker himself.
 
|  |  |
| --- | --- |
| 
 Office Seal:
  | 
 Labour Officer (Social Security Scheme)..............district.
  |
| 
 Place :
  | 
 (Affix Rubber Stamp)
  |
| 
 Date:
  | 
 |
 Acknowledgement Slip
 
 Received from Selvi / Thiru/ Tmt.................application for sanction of assistance towards [accidental death/disability/provision of artificial limbs or wheel chair]
 
 [Substituted for 'accidental death/disability' vide G.O. Ms. No. 64, dated 1.3.2016, published dated 1.3.2016.]
 
 in respect of deceased registered manual worker Selvi/Thiru/Tmt........ (Registration Number.............. )/registered manual worker Selvi/Thiru/Tmt...................... (Registration Number............).
 
|  |  |
| --- | --- |
| 
 | 
 Labour Officer (Social Security Scheme).......... district with date
  |
| 
 | 
 Name:
  |
| 
 Office Seal:
  | 
 Designation:
  |
 [FORM-VIII
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See clause 18 (2) ]
 
 Application For Pension
 
|  |
| --- |
| 
 AffixPassportsizephotograph
  |
 To
 
 The Labour Officer (Social Security Scheme),
 
 ..............................district.
 
### 1. Name of the Applicant ###
 2. Address in full (to which pension is to be sent) (with PIN code)
### 3. Registration number and date (original Identity Card should be enclosed) ###
 4. Age and date of completion of 60 years of age
 Omitted vide G.O. Ms. No. 36, dated 28.02.2011, published dated 01.03.2011
 
### 6. Whether the registration has been renewed regularly without any default? If so, details may be furnished
 
|  |  |  |
| --- | --- | --- |
| 
 Sl.No.
  | 
 Date of initial registration/Subsequent
 
 renewal
  | 
 Period of validity of registration/renewal
  |
| 
 From
  | 
 To
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  |
| 
 | 
 | 
 | 
 |
### 7. Whether in receipt of any other pension? If so, furnish complete details Signature /Thumb impression of the registered Manual worker.
 
 Declaration\*
 
 I hereby certify that the facts mentioned above are true to the best of my knowledge and information. I am not a registered manual worker of any other Board. If ultimately it is found that any of the information given by me is false, I agree to refund the entire amount received by me as pension besides any other action that may be deemed fit by the appropriate authorities.
 
 I also hereby declare that I have not received similar benefits by claim in any other Welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government schemes.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature/Thumb impression of theRegistered Manual Worker.Name
  |
 \*Any false declaration/Certification will entail legal action.
 
 Note. - 1. Besides the photograph affixed above, another passport size Photograph should be enclosed with the application.
 
### 2. Incomplete application will not be considered. Sanction
 
 I hereby sanction, after due verification, a monthly pension of Rs. ......../- (Rupees.............only) with effect from................ The amount shall be sent by money order.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Labour Officer(Social Security Scheme)...........district
  |
 Acknowledgement Slip
 
 Received from Selvi/Thiru/Tmt............... (Address in full).........(Registration No............ application for sanction of pension.
 
 Labour Officer (Social Security Scheme).............district with dateName:Designation:
 
 Office Seal:
 
 [Form- VIIIA
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See clause 18(2) ]
 
 Application For Disability Pension
 
|  |
| --- |
| 
 Passportsizephotographdulysigned
  |
 To
 
 The Labour Officer (Social Security Scheme),
 
 .....................................district.
 
### 1. Name of the Applicant ###
 2. Address in full(to which pension is to be sent)(with PIN code)
### 3. Registration number and date (Original Identity Card should be enclosed) ###
 4. Age and date of completion of 60 years of age
 Omitted vide G.O. Ms. No. 36, dated28.02.2011, published dated 01.03.2011
 
### 6. Whether the registration manual worker of the Board regularly without any default? If so, details may be furnished
 
|  |  |  |
| --- | --- | --- |
| 
 Sl.No.
  | 
 Date of initial registration/Subsequent
 
 renewal
  | 
 Period of validity of registration/renewal
  |
| 
 From
  | 
 To
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  |
| 
 | 
 | 
 | 
 |
### 7. Whether the applicant has become disabled due to sickness and incapacitated from normal work? (If so, a certificate by a Medical Officer not below the rank of Civil Surgeon of the Government Hospital under his name and seal should be enclosed in Original) ###
 8. Whether in receipt of any other pension? If so, furnish complete details
 Signature/Thumb impression of theRegistered Manual worker.
 
 Declaration\*\*
 
 I hereby declare that the facts mentioned above are true to the best of my knowledge and information. I am not a registered worker of any other Board. If ultimately it is found that any of the information given by me is false, I agree to refund the entire amount received by me as disability pension besides any other action that may be deemed fit by the appropriate authorities.
 
 I also hereby declare that I have not received similar benefits by claim in any other Welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government Schemes.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature/Thumb impression of the Registered Manual WorkerName:
  |
 \*\*Any false declaration/certification will entail legal action.
 
 Note. - 1. Besides the photograph affixed above another passport size Photograph should be enclosed with the application.
 
### 2. Incomplete applications will not be considered. Sanction
 
 I hereby sanction after due verification a monthly pension of Rs......../-(Rupees ............only) with effect from.......... The amount shall be sent by money order.
 
|  |  |
| --- | --- |
| 
 Office Seal:
  | 
 |
| 
 Place :Date:
  | 
 Labour Officer (Social Security Scheme)..............district.
  |
 Acknowledgement Slip
 
 Received from Selvi/Thiru/Tmt............(Address in full)................. (Registration No..............) application for sanction of disability pension.
 
|  |  |
| --- | --- |
| 
 | 
 Labour Officer (Social Security Scheme)............district with date
  |
| 
 Office Seal:
  | 
 Name:Designation:
  |
 [Form- IX
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See clause 19(2)  and 20(2)]
 
 Application For Payment Of Funeral Expenses/ Natural Death Assistance
 
 To
 
 The Labour Officer (Social Security Scheme),
 
 .................................district.
 
|  |  |  |
| --- | --- | --- |
| 
 1
  | 
 Name of the deceased registered manual worker
  | 
 |
| 
 2
  | 
 Address in full(at the time of death)
  | 
 |
| 
 3
  | 
 Age(on the date of death)
  | 
 |
| 
 4
  | 
 Nature of work
  | 
 |
| 
 5
  | 
 (a)  Registration Number and date of initial
 
 registration (original Identity card should be enclosed).
  | 
 |
| 
 | 
 (b)  Date of last renewal, indicating the period
 
 up to which renewed
  | 
 |
| 
 6
  | 
 (a)  Place of death
  | 
 |
| 
 | 
 (b)  Date of death
  | 
 |
| 
 | 
 (c)  Cause of death(to be indicated clearly)
 
 (Avoid indicating as "Natural Death") (Death
 
 Certificate in original shall be enclosed)
  | 
 |
| 
 7
  | 
 (a)  Name of the nominee
  | 
 |
| 
 | 
 (b)  Age on the nominee(in completed years)
  | 
 |
| 
 | 
 (c)  Address of the nominee in full indicating
 
 PIN Code
  | 
 |
| 
 | 
 (d)  Relationship of the nominee with the
 
 deceased registered manual worker
  | 
 |
 Signature/Thumb impression of the nominee of theRegistered Manual Worker.
 
 Declaration of the Nominee\*
 
 I hereby declare that the particulars furnished above are correct and true to the best of my knowledge. In the event of any of the information given above is ultimately found to be false, I hereby agree to refund in full the amount received as assistance for death/funeral expenses of the deceased manual worker.
 
 I also hereby declare that I have not received similar benefit by claim in any other Welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government schemes.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature /Thumb impression of the nominee of theRegistered Manual Worker.
  |
 \*Any false declaration/Certification will entail legal action.
 
 Certificate\*
 
 I hereby certify that the particulars furnished in the application are correct.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Members,...........Tamil Nadu..........Welfare Board/President/Secretary of the RegisteredTrade Union of the Employment concernedAssistant Inspector of Labour
 
 concerned/Any other officer permitted to giveEmployment certificate.
  |
 \*Any false declaration/certification will entail legal action
 
 Sanction
 
### 1. I hereby sanction, after due verification, a sum of Rs.............................../ (Rupees........................... only) as assistance to Thiru / tmt. / Selvi............., nominee/ nominees, for the funeral of Thiru/Thirumathi/Selvi ......................................a registered manual worker. ###
 2. I hereby sanction, after due verification, a sum of Rs.............../- (Rupees.............. only) as assistance to Thiru/Tmt/Selvi............. nominee/ nominees, on the natural death of Thiru/Thirumathi/Selvi ............a registered manual worker.
|  |  |
| --- | --- |
| 
 Office Seal:
  | 
 Labour Officer (Social Security Scheme)............district
  |
| 
 Date:
  | 
 |
 Acknowledgement Slip
 
 Received from Selvi/Thiru/Tmt.................claim application for sanction of Funeral/Natural death assistance in respect of deceased registered manual worker Selvi/Thiru/ Tmt...............(Registration No............ )
 
|  |  |
| --- | --- |
| 
 | 
 Labour Officer (Social Security Scheme)...............
 
 district with date
  |
| 
 Office Seal:
  | 
 Name:Designation:
  |
 [Form- X
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See clause 21(3) ]
 
 Application for Education Assistance for pass in 10th Standard and 12th Standard Examination
 
 To
 
 The Labour Officer (Social Security Scheme)
 
 ...................................district.
 
### 1. Name of the registered manual worker ###
 2. (a)  Registration Number and date of initial registration (original Identity card should be enclosed)
 (b) Date of last renewal, indicating the period up to which renewed
 
### 3. Address(in full) with PIN Code ###
 4. Details of family members of the registered manual worker:-
|  |  |  |  |
| --- | --- | --- | --- |
| 
 Sl.No.
  | 
 Name
  | 
 Relationship with the registered manual worker
  | 
 Age
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  |
| 
 | 
 | 
 | 
 |
### 5. Details of the son or daughter for whom educational assistance is sought for:- |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| 
 Sl.No.
  | 
 Name (Son/ Daughter)
  | 
 Date of Birth
  | 
 Examination passed
  | 
 Month and year of pass
  | 
 Name of the School studied
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  | 
 6
  |
| 
 | 
 | 
 | 
 | 
 | 
 |
 Note. - Xerox copy of the Mark Sheet in support of having passed the Examination duly attested by a Group A or Group B Officer should be enclosed.
 
### 6. Number of children for whom the educational assistance has already been availed from the Board:- |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| 
 Sl.No.
  | 
 Name
  | 
 Son/ Daughter
  | 
 Course for which assistance availed
  | 
 Year of availing Assistance
  | 
 Amount of assistance
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  | 
 6
  |
| 
 | 
 | 
 | 
 | 
 | 
 |
 Signature/ Thumb impression of the Registered Manual Worker
 
 Declaration by the Applicant\*
 
 I hereby declare that the particulars furnished above are correct and true to the best of my knowledge. In the event of any of the information given above is ultimately found to be false, I hereby agree to refund in full the amount received as assistance. I further declare that I have not availed similar assistance from any other Welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government Schemes.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature/Thumb impression of theRegistered Manual Worker
  |
 \* Any false declaration/certification will entail legal action.
 
 Certificate\*
 
 I hereby certify that the particulars furnished in the application are correct.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Members,...........Tamil Nadu..........Welfare Board/President/Secretary of the RegisteredTrade Union of the Employment concernedAssistant Inspector of Labour
 
 concerned/Any other officer permitted to giveEmployment certificate.
  |
 \* Any false declaration/Certification will entail legal action.
 
 Sanction
 
 I hereby sanction, after due verification a sum of Rs............../- (Rupees ................ only) as educational assistance, in respect of \*Selvan/\*Selvi .............. \*Son/\*daughter of \*Thiru/Tmt............... Registered Manual Worker (Registration No................).
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Labour Officer (Social Security Scheme)..........................district.
  |
 Acknowledgement Slip
 
 Received from Thiru/Tmt/Selvi/................ (Registration No. .............) claim application for sanction of educational assistance.
 
|  |  |
| --- | --- |
| 
 | 
 Labour Officer (Social Security Scheme)..........................district with date
  |
| 
 Office Seal:
  | 
 Name:Designation:
  |
 [Form- XI
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See clause 21(3) ]
 
 Application for Educational Assistance for Girl Children Studying in 10th Standard/11th Standard /12th Standard
 
 To
 
 The Labour Officer (Social Security Scheme),
 
 ........................................district.
 
### 1. Name of the registered manual worker ###
 2. (a)  Registration Number and date of initial registration (original Identity card should be enclosed)
 (b) Date of last renewal, indicating the period up to which renewed
 
### 3. Address (in full) with PIN Code ###
 4. Details of family members of the registered manual worker:-
|  |  |  |  |
| --- | --- | --- | --- |
| 
 Sl.No.
  | 
 Name.
  | 
 Relationship with the registered manual
 
 worker.
  | 
 Age
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  |
| 
 | 
 | 
 | 
 |
### 5. Details of the son or daughter for whom educational assistance is sought for:- |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| 
 Sl.No.
  | 
 Name
  | 
 Date of Birth
  | 
 Standard in which studying
 
 (Std.10th/11th/12th).
  | 
 Year of study (Indicate the academic year).
  | 
 Name of the School with full address
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  | 
 6
  |
| 
 | 
 | 
 | 
 | 
 | 
 |
 Note. - Certificate from the Head Master/Principal of the School to the effect that the daughter of the registered manual worker is studying the course, should be enclosed.
 
### 6. Number of children for whom the educational assistance has already been availed from the Board:- |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| 
 Sl.No.
  | 
 Name
  | 
 Son/ Daughter
  | 
 Course for which assistance availed
  | 
 Year of availing Assistance
  | 
 Amount of assistance availed
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  | 
 6
  |
| 
 | 
 | 
 | 
 | 
 | 
 |
 Signature/Thumb impression of theRegistered Manual Worker
 
 Declaration by the Applicant\*
 
 I hereby declare that the particulars furnished above are correct and true to the best of my knowledge. In the event of any of the information given above is ultimately found to be false, I hereby agree to refund in full, the amount received as assistance.
 
 I also hereby declare that I have not received similar benefits by claim from any other Welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government Schemes.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature/Thumb impression of theRegistered
 
 Manual Worker.
  |
 \*Any false declaration/certification will entail legal action.
 
 Certificate\*
 
 I hereby certify that the particulars furnished in the application are correct.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Members,........................Tamil Nadu............................Welfare Board/President/Secretary of the RegisteredTrade Union of the Employment concernedAssistant Inspector of Labour
 
 concerned/Any other officer permitted to giveEmployment certificate.
  |
 \*Any false declaration/Certification will entail legal action.
 
 Sanction
 
 I hereby sanction, after due verification a sum of Rs............./- (Rupees .............. only) as educational assistance, in respect of Selvi........ daughter of Thiru/Tmt...............Registered manual worker (Registration No.......).
 
|  |  |
| --- | --- |
| 
 Office Seal
  | 
 |
| 
 Place:Date:
  | 
 Labour Officer (Social Security Scheme)................district.
  |
 \*Strikeout whichever is not applicable.
 
 Acknowledgement Slip
 
 Received from Thiru/Tmt................................................. (Registration No. ....................................................) claim application for sanction of educational assistance.
 
|  |  |
| --- | --- |
| 
 | 
 Labour Officer (Social Security Scheme)...........district with date
  |
| 
 Office Seal:
  | 
 Name:Designation:
  |
 [Form- XII
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See clause 21(3) ]
 
 Application for Education Assistance for Higher Education
 
 To
 
 The Labour Officer (Social Security Scheme)
 
 .................district.
 
### 1. Name of the registered manual worker ###
 2. (a)  Registration Number and date of initial registration (original Identity card should be enclosed)
 (b) Date of last renewal, indicating the period up to which renewed
 
### 3. Address (in full) with PIN Code ###
 4. Details of family members of the registered manual worker:-
|  |  |  |  |
| --- | --- | --- | --- |
| 
 Sl.No
  | 
 Name
  | 
 Relationship with the registered manual worker
  | 
 Age
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  |
| 
 | 
 | 
 | 
 |
### 5. Details of the son or daughter for whom educational assistance is sought for:- |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| 
 Sl.No
  | 
 Name
  | 
 Son/ DaughterDate of birth
  | 
 Name of the course studying
  | 
 Duration of the course
  | 
 Name of the College/ Institution with address
 
 in full
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  | 
 6
  |
| 
 | 
 | 
 | 
 | 
 | 
 |
 Note. - Certificate from the principal of the college/Educational institution to the effect that the son or daughter of the registered manual worker is studying the course indicating whether a day scholar or hosteller should be enclosed in original.
 
### 6. Number of children for whom the educational assistance has already been availed from the Board:- |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| 
 Sl.No
  | 
 Name
  | 
 Son/ Daughter
  | 
 Course for which assistance availed
  | 
 Year of availing Assistance
  | 
 Amount of assistance
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  | 
 6
  |
| 
 | 
 | 
 | 
 | 
 | 
 |
 Signature/Thumb impression of theRegistered Manual Worker
 
 Declaration by the Applicant\*
 
 I hereby declare that the particulars furnished above are correct and true to the best of my knowledge. In the event of any of the information given above is ultimately found to be false, I hereby agree to refund in full, the amount received as assistance.
 
 I also hereby declare that I have not received similar benefits by claim from any other welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government Schemes.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature/Thumb impression of theRegistered Manual Worker.
  |
 \* Any false declaration/certification will entail legal action.
 
 Certificate\*
 
 I hereby certify that the particulars furnished in the application are correct.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Members,..........................Tamil Nadu........................Welfare Board/President/Secretary of the RegisteredTrade Union of the Employment concernedAssistant Inspector of Labour
 
 concerned/Any other officer permitted to giveEmployment certificate.
  |
 \*Any false declaration/Certification will entail legal action.
 
 Sanction
 
 I hereby sanction, after due verification a sum of Rs.................../- (Rupees .......... only) as educational assistance, in respect of \*Selvan/\*Selvi.............. \*Son/ \*Daughter of \*Thiru/Tmt..............Registered manual worker (Registration No......).
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Labour Officer (Social Security Scheme)..................district.
  |
 Acknowledgement Slip
 
 Received from Thiru/Tmt/Selvi/ ............... (Registration No. ..........) claim application for sanction of educational assistance.
 
|  |  |
| --- | --- |
| 
 | 
 Labour Officer (Social Security Scheme)..................district with date.
  |
| 
 Official Seal:
  | 
 NameDesignation
  |
 [Form XIII
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See clause 22(4) ]
 
 Application for Payment of Marriage Assistance
 
 To
 
 The Labour Officer (Social Security Scheme)
 
 ................district.
 
### 1. Name of the registered manual worker ###
 2. Registration Number and Date of initial registration (Original Identity Card should be enclosed)
### 3. Address in full with Pin Code ###
 4. (a)  Particulars of the members of the family of the registered manual worker:
|  |  |  |  |  |
| --- | --- | --- | --- | --- |
| 
 Sl. No.
  | 
 Name
  | 
 Relationship
  | 
 Age
  | 
 Marital Status
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  |
| 
 | 
 | 
 | 
 | 
 |
 (b) (i)
 
 Name of the person for whose marriage the assistance is sought for;
 
 (ii) Relationship to the registered manual worker
 
 (iii) Age in completed years on the date of marriage
 
 (c) Names of the couple - (i) Bride
 
 (ii) Groom
 
 (d) Date and venue of the marriage (Marriage invitation to be enclosed in original)
 
 (e) Has the marriage assistance been availed earlier from the Board? If so, furnish details
 
 Signature/Thumb impression of theregistered manual worker.
 
 Declaration by the Applicant\*
 
 I hereby declare that the particulars furnished above are correct and true to the best of my knowledge. In the event of any of the information given above is ultimately found to be false, I hereby agree to refund in full, the amount received as assistance for the marriage of self/daughter/son.
 
 I also hereby declare that I have not received similar benefits by claim from any other welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government Schemes.
 
 Place:
 
 Date :
 
 Any false declaration/certification will entail legal action.
 
 Signature/Thumb impression of theregistered manual worker.
 
 Certificate\*
 
 I hereby certify that the particulars furnished in the application are correct.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Members,......................Tamil Nadu......................Welfare Board/President/Secretary of the RegisteredTrade Union of the Employment concernedAssistant Inspector of Labour
 
 concerned/Any other officer permitted to giveEmployment certificate.
  |
 \*Any false declaration/Certification will entail legal action.
 
 Sanction
 
 I hereby sanction, after due verification a sum of Rs.........../- (Rupees .......... only) towards assistance of the son/daughter/self of Thiru/Tmt............ registered manual worker of the Board (Registration No..............)
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Labour Officer (Social Security Scheme)..................district.
  |
 Acknowledgement Slip
 
 Received from Thiru/Tmt./Selvi ............(Registration No. ..............) claim application for sanction of marriage assistance.
 
|  |  |
| --- | --- |
| 
 | 
 Labour Officer (Social Security Scheme)..................district with date.
  |
| 
 Official Seal:
  | 
 NameDesignation
  |
 [Form XIV
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See Clause 23(3) ]
 
 Application for Payment of Maternity Assistance for Pregnancy or Miscarriage or Termination of Pregnancy by a Registered Female Manual Worker
 
 To
 
 The Labour Officer (Social Security Scheme)
 
 ..............district
 
### 1. Name of the registered female manual worker ###
 2. (a)  Registration Number and date of initial registration (Original Identity Card should be enclosed)
 (b) Date of last renewal indicating the period upto which renewed
 
### 3. Address (in full) with PIN Code ###
 4. Particulars of surviving son/daughter of the registered female manual worker
|  |  |  |  |  |
| --- | --- | --- | --- | --- |
| 
 Sl. No.
  | 
 Name
  | 
 Sex
  | 
 Date of Birth
  | 
 Age
  |
| 
 1
  | 
 2
  | 
 3
  | 
 4
  | 
 5
  |
| 
 | 
 | 
 | 
 | 
 |
### 5. Month of Pregnancy\* on the date of claim application \*(Certificate from the civil assistant Surgeon of the Government Hospital in support of this should be enclosed in original)
 
### 6. Whether the claim is for pregnancy or miscarriage of pregnancy or termination of pregnancy? If so, details may be furnished. (Certificate from the Civil Assistant surgeon of the Government Hospital to this effect should be obtained and sent in original) ###
 7. Whether the assistance has already been availed by the registered female manual worker? If so, details may be furnished
 Signature/Thumb impression of the registered manual worker.
 
 Declaration by the Applicant\*
 
 I hereby declare that the particulars furnished above are correct and true to the best of my knowledge. In the event of any of the information given above is ultimately found to be false, I hereby agree to refund in full, the amount received as assistance.
 
 I also hereby declare that I have not received similar benefits by claim in any other welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government schemes.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Signature/thumb impression of theregistered
 
 female manual worker.
  |
 \*Any false declaration/certification will entail legal action.
 
 Note. - (i)  The Birth Certificate from the Register of Births of the area concerned should obtained and sent in original for release of the assistance after the date of delivery.
 
 (ii) In the event of untoward demise of the registered female worker after the 7th month of pregnancy either before delivery or three months after delivery, the fact should be reported to the Medical Officer of Primary Health Centre concerned and for Chennai district to the Health officer concerned, immediately along with the Death Certificate in original, for sanction of Funeral Expenses(or)Natural death assistance as admissible under the scheme.
 
 Certificate\*
 
 I hereby certify that the particulars furnished in the application from are correct.
 
|  |  |
| --- | --- |
| 
 Place:Date:
  | 
 Members,........................Tamil Nadu.........................Welfare Board/President/Secretary of the RegisteredTrade Union of the Employment concernedAssistant Inspector of Labour
 
 concerned/Any other officer permitted to giveEmployment certificate.
  |
 \*Any false declaration/Certification will entail legal action.
 
 Sanction
 
 I hereby sanction, after due verification, for the payment of assistance of Rs. ............../- (Rupees......... only) to Tmt registered female manual worker (Registration No...............) \*at the time of seventh month of pregnancy/\*on delivery of child/\*for miscarriage of pregnancy/\*termination of pregnancy(\*Strike out whichever is not applicable).
 
|  |  |
| --- | --- |
| 
 Office Seal:
  | 
 Labour officer (Social Security Scheme)..............district.
  |
 Acknowledgement Slip
 
 Received from Tmt................ registered female manual worker (Registration Number ...........) claim application for sanction of maternity assistance for\*pregnancy/\*miscarriage of pregnancy/\*termination of pregnancy in respect of the registered female manual worker.
 
 \*Strikeout Whichever is not applicable
 
|  |  |
| --- | --- |
| 
 | 
 Labour Officer (Social Security Scheme)..........................district
  |
| 
 Office Seal:
  | 
 Name:Designation:
  |
 [Form XV
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 ]
 
 [See Clause 24(1) ]
 
 Application for Reimbursement of Cost on Purchase of Spectacles by the Registered Manual Worker
 
 To
 
 The Labour Officer (Social Security Scheme)
 
 .........................................district
 
### 1. Name of the registered manual worker ###
 2. (a)  Registration Number and date of initial registration (Original Identity Card should be enclosed)
 (b) Date of last renewal indicating the period upto which renewed
 
### 3. Address (in full) with Pin Code ###
 4. Date of purchase of spectacles and its actual cost
### 5. Whether certificate issued by a registered Opthalmist is enclosed in original? ###
 6. Whether cash bill is enclosed in original?
 Signature/Thumb impression of the registered manual worker.
 
 Declaration by the Applicant\*
 
 I hereby declare that the particulars furnished above are correct and true to the best of my knowledge. In the event of any of the information given above is ultimately found to be false, I hereby agree to refund in full, the amount reimbursement towards purchase of spectacles for myself.
 
 I also hereby declare that I have not received similar benefits by claim in any other welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government schemes.
 
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 Place:Date:
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 Signature/thumb impression of theregistered female manual worker.
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 \*Any false declaration/certification will entail legal action.
 
 Certificate\*
 
 I hereby certify that the particulars furnished in the application from are correct.
 
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 Place:Date:
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 Members,...........Tamil Nadu..........Welfare Board/President/Secretary of the RegisteredTrade Union of the Employment concernedAssistant Inspector of Labour
 
 concerned/Any other officer permitted to giveEmployment certificate.
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 Sanction
 
 I hereby sanction, after due verification, the reimbursement of a sum of Rs............/- (Rupees............ only) to Selvi/Thiru/Tmt. .............., towards the actual cost on purchase of spectacles for himself/herself.
 
 \*Any false declaration/Certification will entail legal action.
 
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 Office Seal:
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 Labour officer (Social Security Scheme)............district.
  |
 Acknowledgement Slip
 
 Received from Thiru/Tmt/Selvi...............registered manual worker (Registration Number.............) claim application for reimbursement of cost on purchase of spectacles for himself/herself.
 
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| --- | --- |
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 | 
 Labour Officer (Social Security Scheme)..........................district.
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 Office Seal:
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 Name:Designation:
  |
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 
 [Substituted by G.O. Ms. No. 122, dated 24.10.2008, published dated 31.10.2008.]
 

