Workmens compensation Act 1923 Employees compensation act v

Workmens compensation Act 1923 (Employees compensation act, )

v Amendment 1)Title: Before Workmen‟s Compensation Act 1923 After - Title of the Act amended to “Employees Compensation Act 1923”. 1)Words and expressions: Before Refer to the • The Employees Compensation Act, 1923 extends to the whole of India. • It came into force on the first day of July, 1924. It is social security legislation. • The Employees Compensation Act, 1923 imposes statutory liability upon an employer to discharge his moral obligation towards employees when they suffer from any physical • disabilities or diseases, during the course of employment in hazardous working conditions. • The aim of the Act is to provide quick and cheaper disposal of disputes relating to the compensation which is not possible in comparison in case of proceedings of civil law. The Act also helps the dependent's to get relieved from the hardship, rising from accident. • Employees Compensation Act, 19 relieved from the hardship, rising from accident.

Employees Compensation Act, 1923 - Factories Plantations Transport Establishments Construction Works Railways Ships Circuses

• Not applicable to: – Members of armed forces of union – Employees covered by ESI Act, 1948. (Dependents benefits available) – Casual Workers & workers employed otherwise than for employer‟s trade or business

Section 2 (1) (b) of the Act define, “Commissioner” as a • Commissioner for Workmen's Compensation appointed under section 20; Compensation [section 2 (1) (c)] means compensation as provided for by this Act; Employer [section 2 (1) (e)] includes: • i) any body of persons whether incorporated or not , ii) any managing agent of an employer , iii) legal representative of a deceased employer, iv) any workman whose services are temporarily lent or let on hire to another person, by the person with whom the workman has entered into a contract of service or apprenticeship; means such other person while the workman is working for him.

• (ii) “Total disablement” means such disablement, whether of a temporary or permanent nature, as incapacitates a workman for all work which he was capable of performing at the time of the accident resulting in such disablement. • Provided that permanent total disablement shall be deemed to result from every injury specified in Part I of Schedule I or from any combination of injuries specified in Part II thereof where the aggregate percentage of the loss of earning capacity, as specified in the said Part II against those injuries, amounts to one hundred per cent or more.

EMPLOYER’S LIABILITY FOR COMPENSATION • • • Ø OCCUPATIONAL DISEASES: 1) Part A of schedule III 2) Part B of schedule III 3) Part C of schedule III Ø PERSONAL INJURY: Personal injury Accident Arising out of employment & in course of employment Ø EMPLOYER IS NOT LIABLE WHEN: Disablement not exceeding 3 days Accident due to influence of drink, drugs or disobeyed orders, disregards of safe guards

Occupational Diseases - Hearing impairment caused by noise. - Lung Cancer caused by asbestos dust. - Diseases due to effect of heat/cold in extreme hot/cold climate, etc.

• The three tests for determining whether an accident arose out of employment are : 1)At the time of injury workman must have been engaged in the business of the employer and must not be doing something for his personal benefit;

EMPLOYER’S LIABILITY WHEN CONTRACTOR IS ENGAGED Section 12 of the act covers the employer‟s liability when contractor is engaged for the purpose of doing any work in respect of employer‟s trade or business. Such contractor has to execute the work with the help of workman engaged by him. But the employers will liable for the payment of compensation only in the following circumstances: • a. ) The contractor is engaged to do a work which is part of the trade or business of the employer. • b. ) The workmen were engaged in the course of or for the purpose of his trade or business. • c. ) The accident occurred in or about the premises on which the employer has under taken or undertakes to execute the work. • This provision, however does not prevent a workman fromrecovering compensation from the contractor instead of the employer. Here, the amount of compensation shall be calculated with reference to the wages of the workman under

Doctrine of Notional Extension • The expression in the course of his employment', connotes not only actual work but also any other engagement natural and necessary thereto, reasonably extended both as regards workhours and work-place. • It refers to the time during which the employment continues… • However, this is subject to theory of notional extension of the employer's premises so as to include an area which the workman passes and re-passes in going to and in leaving the actual place of work. There may be some reasonable extension in both time and place and a workman may be regarded as in the course of hisemployment even though he had not reached or had left his employer's premises. This is also called as the Doctrine of Notional Extension. •

Compensation for What? • Amendments • Sec. 4 (a): -The minimum ceiling limit of compensation for death was Rs. 80000/-Now it has been revised to Rs 1, 20, 000/ • Sec. 4(b): -The minimum ceiling limit of compensation for permanent total disablement was Rs. 90000/-Now it has been revised to Rs 1, 40, 000/ • sec. 4(2): -This sub-section was added after sub-section(2). This entitles an employee to reimbursement of actual medical expenditure incurred by him for injuries caused during the course of employment. • Explanation II to clauses(a)&(b) of Sec. 4: -Explanation –II prescribes the maximum wage limit at Rs. 4000/-p. m. for the purpose of computing compensation for death and permanent disablement. The. Explanation was omitted and a new sub-section (IB) has been added after Sub-section IA of sec. 4 whereby the maximum wage limit has been revised to Rs. 8000/-p. m.

• • • Sec-4 Provides for Compensation for: -Death, -Permanent Total, -Permanent Partial , -Temporary Partial, -Temporary Total

Compensation to be paid • When due? • -as soon as it falls due i. e. liability for payment of compensation is fixed on employer • �If employer do not accept the compensation to the extent claimed: • -should make provisional payment to the extent he accepts • -payment should be deposited with commissioner for employee‟s compensation • -Employee having right to make any further claim. • �Time limit for payment: • -within 1 month from due date • -if not, commissioner direct the employer to pay the arrears with simple interest rate 12% or as prevailing in the bank. • -further delay: -50% of amount due will be recovered as penalty.

Amount of compensation • Section 4: • �Where death of a workman results from the injury: • -An amount equal to 50% of the monthly wages of the deceased workman multiplied by the relevant factor or an amount of, Rs. 1, 20, 000 whichever is more. • �Where permanent total disablement results from the injury: • -An amount equal to 60% of the monthly wages of the injured workman multiplied by the relevant factor or an amount of Rs. 1, 40, 000, whichever is more.

Amount of compensation • Where permanent partial disablement results from the injury (injury listed in part II of schedule I): • -% of loss of earning capacity that such % of compensation payable • �Where temporary total/ partial disablement of a workman results from the injury: • -An amount equal to 25% of the monthly wages payable every half-month

Procedure for calculation • Higher the age –Lower the compensation • -Relevant factor specified in second column of Schedule IV giving slabs depending upon the age of the concerned workman. • �Example: In case of death: • • -Wages Rs. 3000 PM -Age 23 years -Factor as schedule IV : 219. 95 * 1, 500 -Amount of compensation Rs. 3, 29, 935. 00 -In case of total disablement: Rs. 3, 95, 910. 00 �Schedule II: List of persons engaged in different employment. �Schedule III: List of occupational diseases. �Schedule IV: Relevant factor.

Review of Half-Monthly payment • Half-Monthly payment may be reviewed by Commissioner on the application by Employer or employee. • �Application must be accompanied by certificate of qualified medical practitioner that there has been changed in the condition of employee. • �On review, Half-Monthly payment may be continued, increased, decreased, ended or converted into lump-sum.

Defence available to employers before E. C. Act, 1923. • Doctrine of assumed risk „volenti non fit injuria‟-where there is consent there is not injury. • Doctrine of common employment Employer notliable to pay compensation to employee for injury Workerworking with several persons for common purpose. Worker injured by some act or commission of some of the persons of his group. • Doctrine of contributory negligence Employees not entitledto compensation for injury caused by his own negligence. (employer not responsible for negligence on the part of employees. ) • Endof personal action with death. Personal action (of employee) came to an end due to death of employee.

Penalty • Section 4 A: • -Where an employer is in default in paying the compensation due under this Act, within one month from the date it fell due, the Commissioner shall: • a)Direct that the employer in addition to the amount of arrears, pay simple interest there on at the rate of 12% per annum or on such higher rates. • b)Commissioner has the power under the Act to impose penalty and the interest on the cleared amount as per the provision of the act.

Distribution of compensation • Section 8: • �The compensation payable for death and • �The compensation payable to a woman or person of legal disability shall be through the commissioner only. • �Employer can make advance payment directly to dependents in case of death equivalent to three months salary of the deceased person. • �Employer is exonerated from his liability if he deposits the compensation amount with the commissioner within the stipulated time. • �The commissioner shall call dependents of the deceased and determine the method for distribution of compensation among them. • �If no dependents are found then amount shall be refunded to the employer. • �On request by the employer the commissioner shall furnish the details of disbursement.

Contracting Out of the compensation • Section 17 • �Any contract or agreement whereby a workman relinquishes any right of compensation from the employer for personal injury arising out of or in the course of the employment, shall be null and void in so far as it purports to remove or reduce the liability of any person to pay compensation under this Act.

Ways open to employees for claiming compensastion: • • �Injured employee may: -file a civil suit; or -claim compensation under E. C. Act, 1923 �Employee can not file a suit for damages in any court of law if he filed claim under E. C. Act‟ 1923.

Comparison • Civil Suit • • Risky & Costly • Employer can put forward all defenses available to him under laws of torts. E. C. Act, 1923 Safe & less Costly

NOTICE AND CLAIM • Section 10 • �To claim the compensation: • �The claimant shall give notice of accident to the employer or by entering in the notice book within the reasonable period. • �Every such notice shall give the name and address of the person injured, the cause of the injury and the date on which the accident happened and • �Submit the claim application to the commissioner within two years from the date of accident. • �In case of occupational disease the accident is deemed to have occurred on the first day of disease. • �Defect if any in the notice or not giving notice or delayed application will not bar the claim for compensation.

Procedure in the proceedings before the commissioner • • • �Section 19 -Reference to commissioners. �Section 20 -Appointment of commissioner. Section 20 �Section 21 -Venue of proceedings and transfer. �Section 22 -Form of application. �Section 22 A –Power of the Commissioner to require further deposit in case of fatal accident. �Section 23 –Powers and procedure of Commissioners. �Section 24 –Appearance of Parties. �Section 25 -Methods of recording evidence. �Section 26 –Costs. �Section 27 –Power to submit cases. �Section 28 –Registration of Agreements. �Section 29 –Effect of failure to register agreement.

Appointment of commissioner • Section 20 • �The State Government may, by notification in the Official Gazette, appoint any person to be a Commissioner for Workmen's Compensation for such area as may be specified in the notification. • �Any Commissioner may, for the purpose of deciding any matter referred to him for decision under this Act, choose one or more persons possessing special knowledge of any matter relevant to the matter under inquiry to assist him in holding the inquiry.

Reference to commissioners • �Section 19 • � 19(1): -If any question arises in any proceedings under this Act as to the liability of any person to pay compensation (including any question as to whether a person injured is or is not a workman) or as to the amount or duration of compensation (including any question as to the nature or extent of disablement), the question shall, in default of agreement, be settled by a Commissioner. • � 19(2): -No Civil Court shall have jurisdiction to settle, decide or deal with any question which is by or under this Act required to be settled, decided or dealt with by a Commissioner or to enforce any liability incurred under this Act.

Case laws • �State of Kerala v. khadeeja beevi, 1988 • -A govt. servant who is employed as “Mahout” in the forest deptt. is also treated as employee under this act even if he is covered by family pension, GPF, & family benefits scheme under the govt. • �N. A. CHAUHAN v. N. K. SHAH, 1991 • -Expression “arising out and in course of employment”. The words suggest that there should be casual relationship between the employer and accident. • �New India assurance co. ltd. v. Mohan Kumar sahu, 2004 • -Person engaged for one day to drive vehicle of the owner is also the employee in this act. The Owner have definite control over the person. The person was driving the vehicle on the direction of the owner of the vehicle. His engagement for one day only will not throw him out of the definition of Employees u/s 2(n) of the act.

Case laws • �G. S. R. T. C. v/s Ashok Kumar keshavlal Parekh, 1999 • Sec. 16 of Apprentices Act, 1961 entitles a apprentice to claim compensation under this act if Personal Injury caused to him by accident arising out of or in course of his training as an apprentice. • �Radhamony v/s Secretary, Department Of Home Affairs, 1995 • A Person employed as driver comes under the category of employees irrespective of the position whether he is a non-govt. employee or govt. employee. • �Devidayal Ralyaram v/s Secretary of state of AIR, 1937 • According to Doctrine Of Added Peril if a workman while performing his duty does something which is not required to do and which involves extra danger, the employer would not be liable to pay compensation if any injury caused to him.

Cases of Accidents Arising Out of & In the Course of Employment • �Railway employee was ordered to travel to a certain station to repair a water main. When he had finished the work & was crossing the platform to catch the train, he slipped & died as a result. • �A watchman in the course of his duty lifted G. I. Pipe in order to keep it in a safe place. While doing so, he received injury. • �An employee suffered from heart disease & died on account of strain of work by keeping continuously standing or walking. • �An employee suffering from heart disease after having worked for 8 hours on a hot day in a mill collapsed. There was evidence to the effect that collapse was likely to have been caused by strain of work on a diseased heart.

• Workmen's Compensation Act and Medical Examination and Certification under the Workmen's Compensation Act

• Definition and Application: - (1) “The Workmen's Compensation Act is an act to provide for the payment by certain classes of employers to their workmen of compensation for injury by accident” (2) “Work man” means any person (other than a person whose employment is of a casual nature and who is employed otherwise than for the purpose of the employer’s trade or business) who is -

• i) a Railway servant as defined in clause 34 of section 2 of the Railways Act, 1989 (24 0 f 1989)] not permanently employed in any administrative, district or sub-divisional office of a Railway and not employed in any such capacity as is specified in Schedule II or ii) employed in any such capacity as is specified in Schedule II ,

“Partial disablement “ means, • where the disablement is of a temporary nature, such disablement as reduces the earning capacity of a workman in any employment in which he was engaged at the time of the accident resulting in the disablement and, where the disablement is of a permanent nature, such disablement as reduces his earning capacity in every employment which he was capable of undertaking at that time: provided that every injury specified in Part II of schedule I shall be deemed to result in permanent partial disablement;

“ Total disablement” means • such disablement whether of a temporary or permanent nature, as incapacitates a workman for all work which he was capable of performing at the time of the accident resulting in such disablement: provided that permanent total disablement shall be deemed to result from every injury specified in part I of schedule I or from any combination of injures specified in Part II thereof where the aggregate percentage of the loss of earning capacity as specified in the said Part II against those injuries amounts to 100%. or more;

Compensation: • If personal injury is caused to a workman by accident arising out of and in the course of his employment, his employer shall be liable to pay compensation in accordance with the provision of this act provided that the employer shall not be so liable.

• a) in respect of any injury which does not result in total or partial disablement of the workman for a period exceeding three days. b) in respect of any injury not resulting in death or permanent total disablement caused by an accident which is directly attributable to:

• i)The workman having seen at the time there of under the influence of drink or drugs. ii)The willful disobedience of the workman to an order expressively given or to a rule expressively framed, for the purpose of securing the safety of workman or iii)The willful removal or disregard by the workman of any safety guard or other device he knew to have been provided for the purpose of securing the safety of workman.

• Unless otherwise specified, the term "Railway Medical Officer" will mean the following : • (i) Assistant Divisional Medical Officer. • (ii) Divl. Medical Officer. • (iii) Sr. Divl. . Medical Officer

All injury cases to be examined carefully: • It is essential that all Railway doctors should be conversant with the Workmen's Compensation Act as they are likely to be called upon in the discharge of their duties to examine, certify and assess the loss of earning capacity and the consequent compensation to be paid therefor to Railway employees injured on duty and governed by the said Act.

• (2) Besides this, a Railway doctor may have to appear before a Commissioner appointed under the Act to give evidence in cases of dispute between the administration and the employee. It is, therefore, necessary that every case of injury coming under the Workmen's Compensation Act should be viewed as a potential case likely to be brought before a Commissioner and every care should be taken to note down all particulars of such cases.

Medical Examination of injured workmen: - • If a workman sustains injury while on duty, his immediate superior will either arrange for the injured workman to be examined by the nearest Railway Medical Officer at the site of the accident, or will arrange for the injured workman to proceed, or to be conveyed, to the authorised medical officer with a memo on the prescribed form as given in Annexure I to this Chapter. The Railway medical officer, after examination of the injured workman, will issue, if the workman is not fit to return to work immediately,

• a sick certificate in the prescribed form (Sick certificate) as given in Annexure XI to chapter V with a rubber stamp bearing the words: "This injury is consistent with the statement that it was caused by accident", as well as a certificate in the prescribed form as given in Annexure II to this Chapter giving particulars of the part of the body injured, the nature of the injury - whether simple or grievous - and the probable period of disablement, and forward the same to the immediate superior of the injured workman.

Injury Report Register: • (1) An entry of all cases of injuries with which a Railway doctor has to deal must be made in an accident register which is to be maintained in every hospital and health unit. This entry is in addition to the entries made in any other register, such as on daily attendance register or on case papers.

• (2) The entry in the accident register must be made as soon as possible after the patient is seen for this first time and thus becomes an extremely valuable record of the first clinical examination. Sufficient space should be left below the entry so that additional information obtained later on such as Xray reports, admission to hospital, or subsequent death of the patient during the period of treatment for the injuries can be entered neatly and without encroachment on the next entry.

• (3) Records of injuries to employees " on or off duty ", family members of employees and members of the general public must be kept each in a separate section of the register. There should be diagrammatic figures on the reverse of the injury report, on which the details of injuries are to be shown.

• (4) The Railway medical Officer at the time of examination will note carefully the list of injuries on the prescription slips which should not be destroyed as they may be required at any future date for assessing the extent of disablement for purposes of payment of compensation claimed by the injured workman. Prescription slips should also be treated as confidential documents.

Disposal of claim for an injury when no sign of injury is found: • If a patient claims that he is injured and clinical examination shows no sign of injury, these facts must be recorded in the accident register, but all such cases are to be referred to the CMS/MS in-charge of the division.

Caution where no sign of injury is seen. • Attending Medical Officer must make a clear distinction between the complaints of the patient and the physical signs of injuries observed. Doubtful cases should be referred to the CMS/MS in-charge of the Division, postponing a diagnosis and issue of certificate until his advice has been received. Pre-existing disease and deformities must be noted.

Case Sheets: • (1) Case sheets should be made out for all cases of injuries and are to be used for making day-to-day notes on the progress of the cases, instructions from the CMS/MS in-charge of the Division, results of X-ray examination, and so on.

• (2) These case papers are not to be handed over to a patient to be taken home, where it may be lost, mutilated or soiled, as it is a very valuable record of the case subsequent to the first entry in the accident register. It must be retained as an official record.

• (3) CMS/MS s in-charge of the division will make their own local arrangements regarding the safe transmission of these injury case papers from their hospitals to subordinate hospitals and health units. In addition to the records outlined above entries of attendance of the injured person will be made also in the daily attendance register just as for any other patient, and the injury case paper will bear the serial number as recorded in the daily attendance register.

Certification and attendance of injured employees: • (1) All injured employees are to be regarded from the beginning of attendance as persons making a claim or likely to make a claim that the injury was sustained on duty and, therefore, the Railway doctor must not assume that because the accident report in the prescribed form as given in Annexure III has not yet been received, the case is not one coming under the Workmen's Compensation Act, for often the accident report is received by the Railway doctor some time after the accident.

• (2) When an employee attends a Railway hospital or health unit for an injury or alleged injury, he will be issued a sick certificate only if he is unable to perform his duties. If the attending Medical Officer is on doubt regarding the employee's fitness for work or whether the physical signs shown are due to an injury, the case shall be referred at once to the CMS/MS in-charge of the Division, certification being postponed until his advice is received.

• (3) The CMS/MS s in-charge of the Division can make their own local arrangements regarding cases being sent up to them, but it is considered essential that at least all cases of injuries to the eye or of suspected fractures shall be sent to them for examination at once, if the patient is in a position to be transported safely, along with the injury case paper, otherwise, the. CMS/MS in-charge of the Division may be called by theattending Medical Officer to the station where the injured person is lying. In the case of an eye injury, both the eyes must be examined and detailed notes made of their condition, and visual acuity figures recorded.

• 4) In all cases of injury to the eye or near about the eye, vision is each eye at the time of admission and at the time of discharge should be recorded. • (5) If an employee is unfit to work and shows definite signs of injury, a sick certificate is to be issued immediately and if a definite diagnosis cannot be made, the best provisional diagnosis under the circumstances can be entered in the certificate.

• (6) One of the functions of a Railway doctor is to fit work to man and man to work. To do this, close and repeated observation of the conditions and circumstances of work will need to be combined with constant study of men at work. • (7) The Railway doctor should, therefore, see that the workmen are in a good state of health and there is no gross defect in their visual acuity or in the body, which is likely to endanger them or their co-workers' safety.

• 8) Visual acuity of all employees, met with an accident on duty, should be recorded both on the injury case sheet and the accident registe

• (9) Further, when an employee has suffered from an eye injury, before he is discharged to duty, his visual acuity should be examined by the CMS/MS in-charge of the Division, and if his vision is below the standard required for his class of employment then he should be dealt with in accordance with the regulations for the medical examination of non-gazetted candidates and employees. Of course,

• the question of compensation would arise if the defect is due to a permanent injury arising out of and in the course of employment. In cases of injuries other than injury to the eye where visual acuity is found below the standard of his class of appointment, he should be dealt with under the regulations referred to.

Injury resulting in immediate death: • In case of immediate death of a workman resulting from injuries arising out of an accident within the meaning of the Act, the departmental superior will arrange for the immediate attendance of the nearest Railway medical officer. The Railway medical officer, after examination, will issue a certificate in the prescribed form as given in Annexure VI and send the same immediately to the departmental superior concerned.

Injury resulting in subsequent death: • In the first instance, the procedure laid down for an injured workman should be followed. On subsequent death of the workman, the Railway medical officer will issue a certificate in the prescribed form as given in Annexure VII and submit the same to the departmental superior concerned.

Resumption of duty by injured workman: • (1) When an injured workman is fit to resume duty in his original post, the Railway medical officer will issue a fit certificate in the prescribed form (Sick & Fit Certificate)as given in Annexure XI to Chapter V.

• (2) In the event of the injured workman not being fit to resume duty in his original post but fit for other posts, the Railway medical officer will submit a recommendation for alternative employment and follow the procedure laid down for such recommendation.

Issue of fresh certificate when the injury of the injured employee have healed but he acquires any other illness: • If is fairly common for an injured employee to acquire another illness during the treatment for the injury and in such cases when the treatment for the injury is finished and the patient would be fit for duty, but because of the additional illness, he cannot be discharged to duty,

• then the procedure should be that, with the approval of the CMS/MS in-charge of the division, the patient should be issued a fit certificate with regard to the injury and readmitted to the sick-list by the issue of another sick certificate on the same date is respect of the additional illness.

Assessment of loss of earning capacity and issue of certificate: • (1) Before the injured workman is issued a fit certificate for his original post or in an alternative employment, the attending Medical Officer will refer the case to the CMS/MS in-charge of the Division concerned with the full history of the case and recommendation for change of employment, if any, for assessing the loss of earning capacity for permanent, partial or total disablement which may have resulted from the injury.

• The CMS/MS in-charge of the Division will, after personal examination of the case, advise the Medical Officer concerned to issue the necessary fit certificate if the employee is considered by him fit to resume duty in his original post. When it is considered that the employee is not fit to resume duty of his original post and is to be recommended alternative employment, the CMS/Ms in-charge of the division will follow the procedure laid down for the offer of alternative employment

• (2) The CMS/MS in-charge of the division/hospital after personal examination of the case referred by the attending Medical Officer, will assess and certify the loss of earning capacity according to Schedule I of the Workmen's Compensation Act, reproduced in Annexure VIII to this Chapter. Such a certificate should be issued in the prescribed form as given in. Annexure X in triplicate. Two copies should be sent to the department superior concerned

• (3) If D. M. O is in independent charge of a hospital or division the certificate issued assessing the loss of earning capacity according to Schedule I to workman’s compensation Act should be submitted to C. M. D for counter signature. Where CMS/MS is in-charge of the Division/hospital it will suffice if the certificate is counter signed by the CMS/MS in-charge of the division/hospital.

Non-Schedule injuries: • (1) In case of injuries not included in Schedule I as reproduced in Annexure VIII, the CMS/MS incharge of the division will refer the case to the Medical Board for assessment of loss of earning capacity, with full history of the case, giving particulars of the resulting disablement of the workman at that time. The Medical Board after assessment of the Loss of Earning capacity will send their recommendation to the C. M. D for acceptance.

• (2) The Chief Medical Director will, either on the report of the Medical Board, or after personal examination of the injured workman, advise the CMS/MS in-charge of the Division, as early as possible, the loss of earning capacity assessed. The CMS/MS in-charge of the Division will then issue necessary certificate in the prescribed form as given in Annexure X. In all such cases, the decision of the Chief Medical Director will be final.

• (3) The C. M. S/. M. S in charge of the division will send in duplicate the certificate assessing the loss of earning capacity to the departmental superior concerned for necessary action.

Contractor's workmen: • (1) Divisional Officers should advise the CMS/MS incharge of the Division, of cases of workmen who sustain personal injury by accident arising out of and in the course of employment, whilst engaged by contractors for the purpose of carrying out trade or business of the Railway administration, to enable the latter to take necessary action to examine the workman. In cases where the workman engaged by a contractor is treated in a non-railway hospital/dispensary arrangements should be made to have the workman examined before they are discharged from the hospital.

• (2) In the case of grievous hurt to a workman, engaged by a contractor, steps should be taken to record the evidence of the other workmen working on the spot as to how the accident occurred, to enable the administration to decide its liability under the Act.

• ANNEXURE-I • MEDICAL DEPARTMENT WORKMEN'S COMPENSATION ACT • FORM OF MEDICAL MEMO FOR EMPLOYEES ALLEGED TO BE INJURED IN ACCIDENTS COVERED BY THE ACT. • Memo No. . . . . The ADMO/Sr DMO. . . station PERSONS INJURED WHILE ON DUTY The bearer. . . . . is reported to have been injured in an accident arising out of and in the course of his employment at /in the. . . . . on. . . . and is sent for medical examination and treatment. • 2. Cause of injury. . . • 3. Please issue the necessary certificate giving the nature and extent of the injury and the probable period of disablement. • { Signature. . . . Employer • { Designation. . . . {. . . . • Date. . . • Place. . . . • RAILWAY

• ANNEXURE II______RAILWAY WORKMEN’S COMPENSATION ACT INJURY AND DISABLEMENT CERTIFICATEBook No. . . . . Medical Certificate Page No. . . . I have examined. . . . . . . Ticket No. . . . . who met with an accident on. . . . 19. . Part of body injured Gang. . . . . . . . . Nature of injury. . . . . . . His disablement is likely to continue for * more/less than. . . . . days. Date. . . Signature. . . Railway doctor Place. . . . . Designation. . . . .

• • • • ANNEXURE III. . . RAILWAY MEDICAL DEPARTMENT WORKMEN’S COMPENSATION ACT ACCIDENT REPORT Reference No. Department Station Dated 1. Date of accident 2 Time of day at which accident occurred 3. Place at which accident occurred ( if not a Railway’s premises it must be so stated), 4. Nature and cause of accident and detailed statement of the circum – stances under which it happened. 5. Nature of injury sustained, whether slight or serious 6. Name in full 7. Ticket or Gang No. 8. Designation 9. Department

• • 10. Age 11. Date of appointment 12. Address 13. In case of death, name and address of nearest relative or dependent 14. Time and date of accident reported by employee 15. To whom reported 16. Method of report 17. If not reported by employee, how and when did Railway become aware of this accident ? • 18. Did accident arise out of and in the course of his employment ? • 19. If injured person has been disabled, state when first absent through accident. • 20. Was first aid rendered ? If so, by whom ?

• • • 21. Was doctor called in at the time of accident ? 22. If so, name of the doctor 23. Was injured man sent to doctor ? 24. If so, name of the doctor 25. After investigation have you any suspicion – (a) as to the genuineness of the accident ? (b) that it did not occur on duty as described? (c) that the workman at the time was under influence of drink or drug ? (d) that there was willful removal or disobedience of the workman to an order expressly given or to a rule expressly framed for the purpose of securing safety of workman ? • (e) that there was willful removal or disregard by the workman of any safety guard or other device which he knew to have been provided to secure the safety of workman ? • 26. Names and designations of persons who can give corroborative Information ( each must be interrogated before this question is answered).

Eye witnesses Others Station Master Signature Inspector Office-in-charge Designation Foreman

RETIREMENT BENEFITS

Pension Rules will be applicable to: � Staff those who were in service on or after 16. 11. 57 and have opted in favour of pension. � All those employees not governed under SRPF (Contributory) Rules as on 01. 1986. � This pension scheme is applicable only to those employees appointed up to 31. 12. 2003 and not to those who are governed under New Pension Scheme, which was introduced w. e. f 01. 2004.

Retirement: The Railway servant shall retire from service on attaining age of Superannuation at 60 years. Some Railway employees retire voluntarily before the normal retirement. Besides these retirements, the Railway servants become medically invalid (Declared Medically Unfit in all classes) from Railway services and finally in some unforeseen situations the Rly. Servants exit service due to Resignation, Removal or Death. Hence there are various settlement/death benefits that are extended to such retirees / medically unfitted employees / dependents of the demised Railway servants.

Benefits under Normal / voluntary retirement (i) Monthly pension (ii) Retirement gratuity (iii) Commutation of pension (commuted portion of pension will be restored after 15 years) (iv) Group Insurance (saving fund value with interest) (v) Cash Equivalent of unutilised LAP / LHAP (vi) Balance at credit in employee’s Provident fund account (vii) Composite Transfer Grant (viii) Gold plated silver medal. (ix) Kit Pass & Settlement Pass (x) Post Retirement Passes (xi) Medical facilities under RELHS 1997 (xii) Retention of quarters (xiii) Benefits of staying in holiday homes / officer’s rest house

Benefits to family in cases of death of employee while in service: (i) Death gratuity (ii) Monthly family pension (iii) Balance in employee’s Provident fund account (iv) Deposit linked insurance. (v) Group Insurance (full insurance value + saving fund value with interest) (vi) Cash equivalent of unutilised LAP/LHAP (vii) Widow Passes. (viii) Medical facilities. (ix) Retention of quarters. (x) Appointment on Compassionate Grounds.

Qualifying service / Non qualifying service � The service rendered while on duty is qualifying service � All kinds of leave with pay, training period, joining time. � Military service rendered before employment in Railways subject to conditions stipulated. 50% of service from temporary status to the date of regular absorption will be taken as qualifying service for casual labour & ELR services. Non-qualifying service are, Periods of Unauthorised absence, Extraordinary leave taken other than medical grounds, Dies-non, nonregularisation of suspension period, non-payment of foreign service contribution. No weightage (5 years) is allowed for adding qualifying service in

Pension: Pension is payable to a Railway employee on attaining the age (60 years) of Superannuation, absorption in Public Sector Undertaking (PSU), after being declared medically unfit, after compulsory retirement or voluntary retirement or if he is discharged owing to abolishment of post or dismissed shall be entitled to Railway Pension, Gratuity and an option of Commutation of Pension, the general rules regulating Pensions have been mentioned in chapter 2 of the Pension manual.

How Pension is determined? Pension now admissible to the employees as per the 6 th CPC recommendations shall be, 50% of the emoluments or average emoluments whichever is more beneficial subject to the condition that the employee had completed at least 10 years of Qualifying service (in case of superannuation, Compulsory retirement, employees absorbed in PSU) and 20 years in case of employees who retired voluntarily.

Qualifying service is not a criteria for computing Family Pension. At present the minimum pension / family pension payable shall not be less than Rs. 3, 500/- per month as per the recommendation of the 6 th CPC. Ordinary Family Pension: Family pension shall be payable at a uniform rate of 30% of basic pay in all cases and shall be subject to a minimum of Rs. 3500/-p. m + Relief 5 This type of family pension is admissible to widow/widower not remarried, second wife, unmarried/unemployed children born of them who are below 25 years of age, parents, mentally retarded/physically handicapped child of any age and widow/divorcee/unmarried daughter of any age after the death of the employee in service or after the death of the Railway pensioner

The wife, second wife and unmarried/unemployed children below 25 years of age are entitled to enhanced family pension i. e (50% of last pay) up to seven / ten years from the date of retirement /death. The family pensioners falling in second category (parents, Unmarried/divorced, widowed daughter above 25 years of age, mentally retarded/physically handicapped children above 25 years of age) are entitled for ordinary family pension (30% of the last pay) only subject to the condition that their individual income from all sources is less than the minimum pension admissible. In case of 2 wives / child born from out of the second wife, then 50% of Family Pension (even if being the minimum) is paid to each living party. (100% if one party is alive) in case of children below 18 years of age the family pension is paid through a guardian.

The family pensioners of the deceased employees having less than 7 years of qualifying service are entitled for ordinary family pension only and not Enhanced Family Pension. The family pensioner falling in second category is eligible only after expiry of validity of admissibility of family pension of the pensioners falling in the first category.

Enhanced Family Pension (under RSPR 75(4) (i) (a): (Authority: Brd. Letter No. F (E) III/2008/PNI/13, dated: 15. 09. 2008) The enhanced family pension under Rule 75(4)(i)(a) shall be payable to the family of Railway servant, who dies while in service, from the date of death of the Railway servant for a period of 10 years. In such cases, 50% of the pay last drawn by the deceased employee will be payable for first 10 years from the date of demise. In case of Superannuation / Voluntary Retirement / Medical Unfit / Compulsory Retirement, 50% of the pay last drawn by the employee will be payable for a period of 7 years following the date of death of the retired employee or till he would have reached the age of 67 years whichever is earlier.

Life Time Family Pension (Rule-75 (6) (iii) of RSPR 1993) Lifetime Family Pension is payable to an Invalid son/daughter after the death of the railway servant and spouse. It should be certified by a Sr. DMO/RH/ICF that the invalid son/daughters are unable to earn their livelihood. Lifetime Family pension is paid to invalid son/daughter even after attaining the age of 25 years. The pension is stopped from the date when he/she gets married or starts earning for his/her livelihood. Recipient of the Life Time Family Pension should obtain medical certificate once in 3 years from Rly. Medical Authority. The quantum of Pension/Family Pension available to the old family

Age of Pensioner/Family Pensioner Additional quantum of Pension Family pension From 80 yrs. to less than 85 yrs. 20% of basic Pension/ Family pension From 85 yrs. to less than 90 yrs. 30% of basic Pension/ Family pension From 90 yrs. to less than 95 yrs. 40% of basic Pension/ Family pension From 95 yrs. to less than 100 yrs. 50% of basic Pension/ Family pension 100 years or more 100% of basic Pension/ Family pension Note: From 80 years means after the completion of 80 years and not from the beginning of 80 yrs. of age.

Calculation of Pension: Minimum Pension / Family Pension Rs. 3, 500/- + Dearness relief Maximum Pension Rs. 40, 000/- + Dearness relief Maximum family pension Rs. 24, 000/- + Dearness relief Formula for Calculation: Last Pay Drawn /2 (or) Average emoluments of last 10 months pay / 2, whichever is beneficial to the employee.

Commutation of Pension: Railway servant retiring on superannuation / VR or on compensation pension can opt for commutation of pension not exceeding 40% of the pension sanctioned No commutation is paid to the employees against whom D&AR / criminal case is pending. Commutation will be paid to Medically unfit / Compulsorily retired employees only after medical examination by Railway doctor. Formula : 40% of the pension (x) 12 (x) Age factor (age on next birthday) Example: If original Pension is Rs. 7295/- for a Railway servant retiring on superannuation the commutation value would be as under: Commutable portion of pension is = 7295 X 40% = Rs. 2918 Commutation = 2918 X 12 X 8. 194 (age factor for next birthday) = Rs. 2, 86, 922/8

Illustration-I (More than 10 Years) For Superannuation / VR/MU/CR Date Of Appointment 18. 01. 1984 Date Of Birth 06. 10. 1950 Date Of Exit 31. 10. 2010 Qualifying Service (DOR-DOA) 27 Yrs a) LAST PAY DRAWN Rs. 14, 590/- (5200 -20200+2800) b) Full Pension Rs. 7, 295/- (Rs. 14, 590/(Last Pay. Drawn)÷ 2 c) Commuted Pension (40% of b) Rs. 2, 918/d) Reduced Pension (b-c) Rs. 4, 377/- + Relief as on Full Pension

Illustration – II (For Demise Case) Date Of Appointment 21. 02. 1987 Date of Death 29. 06. 2010 Qualifying Service DOD-DOA 23½ Yrs LAST PAY DRAWN Rs. 12, 500/- (5200 -20200+2800) Family Pension @ 30% of Last Pay drawn + relief a) Enhanced Family Pension Rs. 6250+Relief (Rs. 12500 (Last Pay Drawn)/ 2 (From 30. 06. 2010 to 29. 06. 2020) b) Ordinary Family Pension (3750+Relief (from 30. 06. 2020 on wards)

Restoration of Pension Commuted portion of pension will be restored after the completion of 15 years from the date of commutation. The date for restoration of Commuted portion of Pension will be exhibited in the Pension payment Order and the Pensioner can approach the Bank Authorities for restoration after 15 yrs. The Pensioner can approach the Personnel/ Accounts Branch for assistance if any in case of difficulty. Revision of pension: Consequent to change in circumstances such as implementation of recommendations of different type of orders with respect to fixation of pay, granting of increment, removal of anomaly and Pay Commission the pension undergoes revision. The difference of pension, gratuity and commutation value of additional amount will be paid

Cash Equivalent to Leave Salary The employee at the time of settlement is entitled for leave encashment of leave at his credit for a maximum of 300 days (Unutilized LAP). As per the 6 th Pay Commission the shortfall in 300 days LAP can be filled by adding LHAP. If an employee for an example, has only 285 days of LAP balance at credit at the time of Retirement and enough number of balance days of LHAP at credit, then for the purpose of computing Leave Encashment, only 15 days of LHAP will be taken into account, even though he would have had more than 15 days of LHAP. (i. e) The retiree will be paid for 285 days of Leave on Average Pay plus (+) 15 days of Leave on Half Average Pay.

Leave Encashment 1. Max. 300 days (LAP + HLAP) 2. (B. Pay + DA ) x 300 days 30 3. No limit as to maximum amount

Illustration: If last pay drawn is Rs. 12450/- then the leave encashment would be Last pay drawn + 58% DA(applicable as on date) x 300 days / 30 days =12450+7221 x 300/30 = Rs. 1, 96, 710/In case the employee has 285 days LAP and 50 days of LHAP at his credit then the leave encashment would be as follows: 12450+7221 x 285/30 = Rs. 1, 86, 874/-

Provident Fund: The amount of PF subscription and VCPF deducted from monthly salary and the interest thereon will be paid to the railway servant at the time of retirement or in the event of death to the nominees as the case may be. The Railway servant may draw 90% of the PF amount at his credit 12 months before retirement without assigning any reason for preparatory to his retirement. The recovery of PF in respect of Railway servant will not be made in last three months of his retirement.

CGEGIS (Central Government Employees Group Insurance Scheme) This scheme came into effect from 1 -1 -1982. The rates of subscription per month shall be as follows: Group Monthly recovery Insurance cover Group C & D Rs. 30, 000/Group B Rs. 60, 000/Group A Rs. 120 Rs. 1, 20, 000/In case of death of employee the amount of insurance covered and contribution with interest will be paid to the family / nominee. In the case of retirement, only savings portion of the subscription plus interest will be paid to the Railway servant.

Medical Facilities For Retirement/VR: A minimum period of 20 years qualifying service is required for Railway servant to join the RELHS 1997 (Retired Employees Liberalised Health Scheme’ 97) and such Railway servant shall exercise option three months in advance prior to his retirement to join the Scheme. For Demise/Medical unfit This scheme is open to the spouses of the Railway employees who die in harness and for those employees who retire on Medical Unfitness. 11 The condition of completion of 20 years of qualifying service in Railways for such case is not required. The retiring employee/ Spouse of the railway servant is required to make a one time contribution equal to the last month’s basic pay (pay in the Pay band + grade pay) at the time of retirement/demise/medical unfit. If opted, the contribution will be deducted from his gratuity amount due. A medical identity card will be issued with photographs of all the beneficiaries. On receipt of the Identity card they shall make an entry in the Medical ID Card with the respective Hospital/Health units.

Fixed Medical Allowance (FMA) Retired employees with 20 years of qualifying service are eligible for grant of FMA at the rate of Rs. 300/- per month and the same is paid along with pension / family pension subject to the following conditions. (i) The pensioner/family pensioner is residing beyond 2. 5 kms from the nearest health unit. (ii) The pensioner/family pensioner is not availing the facility of OPD (except in cases of chronic diseases) Joining RELH Scheme is not a pre condition to claim FMA mere eligibility to enrol under the scheme is sufficient. The widow who has been appointed on Compassionate grounds is not eligible to draw FMA.

Post Retirement Complimentary and Special Passes Post retirement passes are issued to the retired employees and to their eligible dependents in the event of death or exit from service. Entitlement for post retirement complimentary passes Service rendered No. of Passes in Rlys. Group “A” & “B” Group “C” Group “D” 20 yrs and above 2 sets 1 set but less than 25 yrs and above 3 sets 2 sets 1 set

Training period before absorption into regular posts is reckoned for counting of Rly service for determining eligibility for post retirement passes. Continuous service rendered after attaining temporary status is counted for service for determining eligibility for post retirement passes. The following services are also reckoned for determining the eligibility for post retirement passes: 1. Training period before absorption to regular post. 2. Services rendered by canteen employees in statutory and non-statutory canteens. 3. 50% of the services rendered in other PSUs/military to make up any shortfall in services to fulfil the qualifying service of 20 years. Retired employees/widows are not entitled for PTO.

GRATUITY: Retirement Gratuity: This is a lumpsum payment granted to a Railway servant on his/her retirement or medical invalidation. Retirement Gratuity is payable to: � Those Railway servants who had completed 5 years of qualifying service the retirement gratuity is payable at a rate of 1/4 th of emoluments for each completed 6 monthly period of service subject to maximum of 16½ times. � Maximum amount payable is Rs. 10, 000/- w. e. f. 01. 2006. � Maximum qualifying service for computation of gratuity is 33 years

Formula for calculation: Last Pay drawn + DA x Qualifying Service / 2 Example 1: If Last Pay drawn is Rs. 12, 450 (Rs. 10, 050 + GP Rs. 2400) and DA is 58% Qualifying service is 33 years at the time of retirement, then the retirement gratuity would be: Gratuity = 10050+2400+58% DA x (16 ½ times) = Rs. 3, 24, 572/-

Service gratuity: � Service Gratuity is granted to those railway employees who exit from service before completion of 10 yrs of service. It is payable in addition to the Retirement Gratuity if eligible. 3 � Dearness Allowance is also included. � This is paid at the rate of half of his emoluments for every completed 6 monthly period of qualifying service. Example: (If service is less than 10 years) If Last Pay drawn is Rs. 12, 450 (Rs. 10, 050 + GP Rs. 2400) and DA is 58%, Qualifying service is 8. 5 years at the time of retirement, then the service gratuity would be: 10, 050+2, 400+58% DA X 8. 5 (No. of yrs. of Q. S) =

Death Gratuity : If a Railway servant expires while in service the amount of Death gratuity shall be paid to the family as under: Less than 1 year 2 times of emoluments 1 year or more but less than 5 years 6 times of emoluments 5 years or more but less than 20 years 12 times of the emoluments 20 years more ½ of the emoluments for every completed 6 monthly period of qualifying service subject to maximum of 33 times of emoluments.

Example: If Last Pay drawn is Rs. 12, 450 (Rs. 10, 050 + GP Rs. 2400) and DA is 58% and the Qualifying service is 23. 5 years at the time of retirement, then the amount of Death gratuity would be Rs. 4, 62, 269/- (i. e 10050+2400)+58% DA x 23. 5 (No. of Q. S) 4 Nominations: The Railway servant while in service shall declare his family and make nominations in the appropriate Forms, as provided in the Railway Services Pension Rules 1993 for Pension, DCRG, CGEGIS and PF as per IREC.

Settlement Pass / Kit Pass Employee in the event of retirement and widow/widower in the event of death of employee are issued passes for self/family members/dependents for transportation of personal effects to the place where employee / family intend to settle after retirement/death of employee. Such an application for settlement pass shall be submitted within one year of retirement / death and the pass is valid for a period of three months. However, GM can condone delay up to two years from the date of retirement /death. Kit pass is admissible for free transportation of house hold effects up to specified limits in terms of Bd’s Letter No E (W) 96 PS 5 -9/1 dated 1/6/2000. Revised entitlement of kit pass on implementation of VI CPC recommendations have been issued in terms of Bd’s letter No. E (W) 2004 PS 5 -9/1 dt 17. 06. 09

Widow Complimentary Pass Widow / widower of the retired employees who have opted for the widow pass scheme are eligible for half the number of post retirement pass that her / wife would have been eligible for the service rendered / or was receiving at the time of his / her demise of the retirement. In case of demise of the railway servant even the service rendered is less than 20 years, widow / widower is entitled for grant of one set of pass every alternative year. Availing of Pass after Retirement / Demise of the Railway servant Retired employees /spouse of the deceased employee may avail their Pass either in the place of retirement or at the place of stay. The Pass can be availed by the employee / spouse either in person or sending the request by registered post.

Provision of Companion in lieu of Attendant in Post Retirement Complimentary Pass. Retired Railway employee/widow of 70 years of age and above, who are entitled for I class / I A post retirement complimentary / widow passes, may be allowed to take a companion in the same class by paying 1/3 rd of difference of fare between sleeper class / second class and the higher class in which the retired railway employees / widow travels in all trains including Rajdhani / Shatabdi trains, subject to the existing restriction regarding number of berths in Rajdhani/Shatabdi trains. However, Retired Railway employee/widow of 65 years of age and above but below 70 years who are entitled for I class / I A post retirement complimentary passes may be allowed to take a companion in the same class by paying full difference between the Sleeper class/II Class and the class in which the Pass holders travel, besides the existing travel facility along with the companion in Sleeper class/II class.

No age limit for Companion. The above provision is not available when the family members of the retired employee of age below 65 yrs travel with the retired railway employees/ spouses Eligibility members for Post Retirement Complimentary Passes The retired employee can include his own family members for issue of complimentary pass. Widow mother /widow and legally divorced daughter can also be included. Dismissed and removed employees on or after 26. 10. 2005 whose Gratuity / Pension withheld / cut consequent on D&AR actions are not eligible for Post retirement Pass but eligible when they are granted compassionate allowance.

Option for Widows Appointed on Compassionate Grounds for Drawl of Widow Passes Widows appointed on compassionate grounds as Railway employees have one of the two options for drawal of passes on their appointment andretirement. · They can either draw passes in their capacity as Railway employee(or) · They can avail Widow Pass in her capacity as widow of deceased employee. Option once exercised shall be final

Advance Passes If the current year’s passes are exhausted by the retired railway servant, he can avail of passes from the next year’s pass account as advance pass. Such advance pass can be applied 100 days in advance. Special Pass on Medical Grounds Retired employee/spouse suffering from heart ailment / cancer who joined in RELHS 1997, are eligible for issue of special passes on medical grounds from the place of residence to the hospital referred and back with the recommendation of the competent hospital authorities.

Other conditions and entitlement: In cases where both husband wife are retired railway servants they may avail the complimentary passes on each account. When a totally blind retired railway servant (blind in both eyes) if travels alone can take one attendant in the same class eligible to him on production of certificate from the medical officer concerned, duly including attendant’s name in the Post retirement pass. A child adopted after retirement may be included in the post retirement Complimentary Passes with necessary proof for adoption. A photo identity card to the retirees and spouses is issued to avail post retirement passes and they should carry the ID card while on travel. Validity of ID card for Post Retirement / Widow pass holders is 7 years.

Composite Transfer Grant (CTG) CTG at the rate of one-month basic pay is granted to the retired railway servant to transport his personal effects to his place of settlement when the place of residence changes beyond the radius of 20 kilometers and 1/3 rd of one month basic pay in the same station within the radius of 20 kilometers. Merely the proof for change of residence is sufficient to claim CTG and the same shall be claimed within one year from the date of retirement and beyond one year, GM has power to condone the delayed claim.

Quarters on Retirement The retired Railway Servant is entitled to retain the quarters for a period of 4 months on normal rent and for another period of 4 months on educational/medical grounds on twice the normal rent. In the case of a Deceased employees’ family members, they can retain the quarters for a period of 24 months. DCRG will be released on vacation. Holiday Homes There are several Railway Holiday Homes available throughout the Indian Railways. The retired railway employees can avail the benefit of accommodation of Holiday Homes on par with the serving railway employees.

1 Full Name (in Block Letters) F/NAME M/NAME SURNAME 2 Fathers/Husband's Name M/NAME SURNAME 3 Date of Birth DOB 4 Date of Appointment DOA 5 Designation DESIG. - STN. , Under: UNIT 6 RUID Number 7 Basic Pay B. PAY 8 Pay Level GP 9 SRPF No. PF NO. 10 PAN No. E-PAN 11 Mobile Number MOBILE 12 E-mail Id 13 Aadhaar No 14 Mark of Identification 1 E-ADHAR I/MARKS-1 2 I/MARKS-2 15 Religion RELIGION 16 Present/Correspondence Address with PIN Code ADDRESS, STATE, CITY - PIN 17 Permanent Address with PIN Code ADDRESS, STATE, CITY - PIN 18 Details of Railway/ Directorate of Estate Quarter, if allotted Rly. Qtr. No. QTR. NO. , Type: TYPE, Location: LOCATION, Rent : Rs. RENT RS. Date of Vacation of Rly. Otr. VACATION o x Employee's Signature Name: F/NAME M/NAME SURNAME, Designation: DESIG. , Under: UNIT

19 Date of Retirement DOR 20 Date of start of Pension NEXT DAY OF DOR 21 Class of Pension (Superannuation / Voluntary etc. ) 22 Details of Public Sector Bank from where pension will be drawn : (a) Savings Bank Account No A/C NO. (b) Name of Bank BANK (c) Branch BRANCH (d) City (e) District (f) IFSC 23 Medical facility being availed at present (CGHS / RMA) 24 Medical Card(s) No. 25 Details of Military / Other Service, if any a. Total Period of Military Service b. Amount of gratuity received for the Military Service c. PPO No & Date of Issue (attach a self attested photocopy of the PPO From: To : , DTD. Note : Please attach : (i) A canceled cheque, issued for Bank Account mentioned above at Sr. No. 21. (ii) Self attested photocopies of PAN, Aadhaar and Medical Cards Place : STN. Date: . . . . o x Employee's Signature Name: F/NAME M/NAME SURNAME, Designation: DESIG. , Under: UNIT

DECLARATION FOR NON ACCEPTING COMMERCIAL EMPLOYMENT I note that I cannot accept any commercial employment before the expiry of one year from the date of retirement, or any employment under a government outside India at any time without prior sanction of the President of India. I can not seek employment as contractor for or in connection with the execution of public works (Whether on the Railways, or under P. W. D. or Defence Forces) or employment of such contractors, within one year of my retirement, without the prior permission of the President of India.

DECLARATION FOR NON RECEIPT OF PENSIONARY BENEFITS I hereby declare that I have neither applied for nor received any ordinary Gratuity/ Pension/ Death-cum -retirement Gratuity in respect of any portion of the service included in this application and in respect of which ordinary Gratuity/Pension/Death-cum-Gratuity is claimed herein, nor shall I submit an application hereafter without quoting a reference to this application and to the orders which may be passed thereon.

I am in occupation of Railway I Directorate of Estates' (DOE) House No. QTR. NO. , TYPE, LOCATION, VACATED ON VACATION on my retirement from Railway Service, agree to withhold Death-cum. Retirement gratuity as per extant orders till such time, I vacate the Railway Quarter/DOE accommodation. x Employee's Signature Name: F/NAME M/NAME SURNAME, Designation: DESIG. , Under: UNIT

1 st Witness Signature : o. . . . . Name Designation RUID No. 2 nd Witness Signature : : : . . . . . . : . . Name : . . Designation : . . . . RUID No. : . . . . Note : After vacating the government accommodation, employee may apply for refund of withheld gratuity in prescribed performa, along with all required documents. In case of Directorate of Estates' accommodation, the retiring employee has to apply online for obtaining the "No Demand Certificate·".

DETAILS OF FAMILY MEMBERS 1. 2. Name and Designation of the employee: F/NAME M/NAME SURNAME Designation: DESIG. , under: UNIT Father's/Husband's Name : M/NAME SURNAME Affix Joint Photo (to be duly signed across by self and spouse) Affix Employee's Photo

3. Sr. No. Details of all family members : - Name (in Block Letters) 1 Relationship with Railway Servant 2 Date of Birth (attach a photocopy of valid document as proof) 3 Aadhaar No. (attach a photocopy of Aadhaar Card) 4 5 (i) F/NAME SELF DOB E-ADHAR (ii) W/IFE W-REL W-DOB W-ADHAR (iii) NAME-1 RELA-1 DOB-1 ADHAR-1 (iv) NAME-2 RELA-2 DOB-2 ADHAR-2 (v) NAME-3 RELA-3 DOB-3 ADHAR-3 (vi) NAME-4 RELA-4 DOB-4 ADHAR-4 (vii) NAME-5 RELA-5 DOB-5 ADHAR-5 (viii) NAME-6 RELA-6 DOB-6 ADHAR-6 (ix) RELA-7 DOB-7 ADHAR-7 NAME-7

Sr. Date of marriage No. in case of married children Name of spouse of married child Indicate the nature Remarks/An of handicap y other (mental/physical) , if any, information of the child and whether it is permanent or temporary 6 7 8 9 (i) --- --- --- (iii) MAR/SEP/DEATH-1 SPOUSE-1 (iv) MAR/SEP/DEATH-2 SPOUSE-2 (v) MAR/SEP/DEATH-3 SPOUSE-3 (vi) MAR/SEP/DEATH-4 SPOUSE-4 (vii) MAR/SEP/DEATH-5 SPOUSE-5 (viii) MAR/SEP/DEATH-6 SPOUSE-6 (ix) SPOUSE-7 MAR/SEP/DEATH-7 Employee's Signature Name: F/NAME M/NAME SURNAME, Designation: DESIG. , Under: UNIT

4. Three specimen signature, Identification Mark(s) and Fingers' Impression of left hand of the Railway Employee : (a) Specimen Signature x x x (b) Identification Marks : (i) W-MOI (ii) I/MARKS-2 (c) Fingers' Impression of Left Hand: Thumb Index Finger Middle Finger Ring Finger Little Finger

5. Three specimen signature, Identification Mark(s) and Fingers' Impression of left hand of Spouse: (a) Specimen Signature * * * (b) Identification Marks: (i) W-MOI (ii) (c) Fingers' Impression of Left Hand: - Thumb Index Finger Middle Finger Ring Finger Little Finger

Place: - STN. , Date: -. . . . o x Employee's Signature Name: F/NAME M/NAME SURNAME, Designation: DESIG. , Under: UNIT Certified that the joint photograph pasted at pre-page (Column 2) is of Smt. & Shri F/NAME M/NAME SURNAME and the information declared from Column No. 1 to 5 by the Railway employee are believed to be true and both persons signed and put fingers' impressions before me. Signature of the Gazetted Officer Name: . . Designation : . . . . Rubber stamp with name of certifying authority

LETTER OF AUTHORITY UNDERTAKING FOR DRAWAL OF PENSION THROUGH PUBLIC SECTOR BANK WITH PERMANENT ADDRESS & MODE OF PAYMENT

2. I agree to undertake that any amount excess/wrong payment of pension if credited to my above savings bank account may be recovered or withdrawn from the said savings bank account by the public sector bank. 3. The authority shall remain in force until due notice in writing is given by me.

PAYEE'S LETTER OF AUTHORITY I request that my Provident Fund and Death-cum-Retirement Gratuity/Compassionate gratuity/Leave Encasement/SRPF/CGEGIS/Pension Commutation amount may be remitted to me through ECS/RTGS/NEFT. I agree that the remittance made in the aforesaid manner shall be at my sole risk and shall be a complete discharge of Government from all liability on the amount being remitted by ECS/ NEFT /RTGS/Money order/Cheque/Bank Draft forwarded by registered post, as the case may be.

PRE – RECEIPT Received from SR. DFM – , (Pay & Accounts Officer), a sum of Rs as full and final settlement of my claim to Provident Fund Amounts/Gratuity/Compassionate gratuity/Leave Encashment / GIS / Pension on Commutation Value :

Signature of Head of office* (Stamp). . . * Head of Office, means a gazetted officer whom the appointing authority may, by order declare as Head of office and includes such other authority or person whom the appointing authority may specify in the like manner.

NO DUE CERTIFICATE BY UNIT INCHARGE. THIS IS TO CERTIFY THAT THERE IS NO OUTSTANDING T&P/ STOCK SHEET AGAINST SHRI/SMT F/NAME M/NAME SURNAME Designation: - DESIG. , Station / Unit: - STN. - UNIT WHO IS RETIRING ON DOR o SIGNATURE OF SUPERVISOR.

RETIRED EMPLOYEES LIBERALIZED HEALTH SCHEME (RELHS). To, The DRM (E) /. Sub: Retired Employees Liberalized Health Scheme (RELHS). I. employees liberalized health scheme " vide Board's Letter No. 86/H/6 -2/21 Dt. 28/9/98 by paying onetime payment equal to the last one months Basic pay at the time of Retirement/Superannuation. II. I am also enable could opted for existing contributory health scheme by paying half yearly/yearly contribution but I have opted for the new Liberated Health Scheme. III. Two copies of passport size photograph of self/wife husband dependent widow mother Dependent children/ dependent parent are enclosed. IV. Following are my service particulars and other details.

1. Name of the retired Rly. Employee as registered in Rly. Book: - F/NAME M/NAME SURNAME. 2. Designation deptt. of the retired employee. DESIG. -STN. , UNIT 3. Name of Wife/Husband with age: - W/IFE , DOB: W-DOB 4. Name of Dependent children with age and other details NO. NAME RELATION MARITAL STATUS DOB 1 RELHS-1 RELA-R 1 MD/UM-1 DOB-R 1 2 RELHS-2 RELA-R 2 MD/UM-2 DOB-R 2 3 RELHS-3 RELA-R 3 MD/UM-3 DOB-R 3 4

5. 6. 7. 8. Name of Dependent with age and other details Date of Retirement from Railway service: - DOR Last month's basic pay at the time of retirement: Rs. B. PAY Mark of identification of the employee mentioned above: (i) I/MARKS-1 (ii) I/MARKS-2 9. Last Bill preparing unit: - BILL UNIT 10. Opt for Medical Allowance Rs. 1, 000/YES or NO: - M/ ALLOW. Kindly attest the Photographs and issue identity medical card pass "Retirement Employee Liberalized Health Scheme” for Medical facilities from Railway Hospital/Health unit and to remit the onetime payment to chief Cashier / BVP. I will avail this facility under CMS - M/UNIT.

-: Declaration: I, Shri F/NAME, son/daughter/wife of Shri M/NAME SURNAME , Design: - DESIG. -STN. , do hereby OPT to join the Retired Employee's Lib. Health Scheme. I clearly understand that the contribution to join RELHS is equal to last month’s basic pay. This contribution may be / may not be deducted from my settlement dues. I clearly understand that my unmarried son/sons are eligible for RELHS as he/they are fully dependent on me due to his/their income is below Rs. 2500/- per month. ADRESS: X Name: - F/NAME M/NAME SURNAME. o

ANNEXURE-1. UNDERTAKING FORM (to be submitted in DUPLICATE by pensioners / family pensioners to his / her Pension Disbursing Authority (PDA) one copy to be retained by PDA and other copy to be furnished to Pension Sanctioning Authority by PDA). 1. I F/NAME M/NAME SURNAME, Designation: DESIG. - STN. , under: UNIT, aretired employee / family Pensioner whose spouse was an Employee declare that i am residing at. ADDRESS, STATE, CITY-PIN. (indicated in the P. P. O. ) Which is beyond 2. 5 KM from the nearest railway Hospital/helth unit (name of the hospital / heath unit) as contained in Annexure III to Railway Board’s letter No. PC-V/98/I/7/1/1 dated 21. 04. 99).

2. Accordingly, I hereby opt to claim fixed medical allowance of Rs. 1, 000/- per month. Necessary endorsement may please be made in my PPO in this regard. Simultaneously, I undertake that I will not avail of OPD facilities at Railway hospitals / health units from the day I claim Medical Allowance. I also understand that grant of Medical Allowance is subject to the terms and conditions specified in Board’s letters No. PC-V/98/I/7/1/1, dtd. 21. 04. 99 and 01. 03. 04.

3. I also declare that I have not availed of any treatment as Out Door Patient for the period from ________ (indicate here the date of retirement of the date of availing OPD facility on the last occasion or 1. 12. 1977, whichever is later) to ____________ (indicate here the date on which this declaration is signed). I may accordingly be paid arrear of Medical Allowance @ Rs. 100/- per month for the period mentioned above. X Signature Name: - F/NAME M/NAME SURNAME PPO No: - ……………. . . Issued by Bank Name: - BANK Branch: - BRANCH Account No: - A/C NO. o Place: - STN. Date of Retirement; - DOR

URGENT STATEMENT CERTIFICATE. (To be filled in by Supervisory Staff). (In case of any employee working under him when retired/ resigned/ dismissed/ died etc. , and to be returned to Estt. Welfare / Settlement Section DRM's Office -. ) No. DETAILS PARTICULARS 1 NAME F/NAME M/NAME SURNAME 2 F/NAME M/NAME SURNAME 3 DESIGNATION DESIG. 4 STATION STN. 5 ADDRESS STATE CITY - PIN 6 CONTACT NO. MOBILE 7 DOB DOA 8 DOR BILL UNIT 9 PB & GP PB + GP 10 PF No. 11 12 UNIT BASIC PAY B. PAY LAST PF Recovery Rs. PF RECOV. Month RLY. QTR. NO. Type ELECTRIFIED? Rly. Qtr. Location LOCATION Unit PF NO. TYPE

13 Date of Vacation VACATION 14 OUTSTANDING RECOVERIES TO BE MADE FROM SETTLEMENT i) Pay & Allowance ii)Leave adjustment RENT Rs. RENT RS. iii) Rent Cess/Electric charges iv) T & P and Uniforms v) Festival & Other Advances vi) Advance bearing interest vii) Food or Cycle Advance viii) Any other Recoveries 15 Details of Immediate Relief, if any Rs. 16 Outstanding JC Bank Recovery 17 REMARKS, IF ANY Dt. From: Signature & Stamp Station: STN. of Supervisory Staff Note: - If Leave Account Maintained by the Supervisory Staff the same should be sent to this Office duly completed if not sent.

THANKS