The Delhi Building and Other Construction Workers (RE and CS) Rules, 2002

FORM I

(SEE RULE 23[1])

APPLICATION FOR REGISTRATION OF ESTABLISHMENTS EMPLOYING BUILDING WORKERS

Name and location of the Establishment where building or other construction work is to be carried on.
Postal address of the Establishment.
Full name and permanent address of the Establishment, if any.
Full name and address of the Manager or person responsible for the supervision and control of the Establishment.
Nature of building or other construction work carried/is to be carried on in the Establishment.
Maximum number of building workers to be employed on any day.
Estimated date of commencement of building or the other construction work.
Estimated date of completion of the building or other construction work.
Particulars of demand draft, enclosed (name of the bank, amount, demand draft No. and date).

DECLARATION BY THE EMPLOYER

I hereby declare that the particulars given above are true to the best of my knowledge and belief.
I undertake to abide by the provisions of the Building and other Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996 and the Rules made thereunder.

PRINCIPAL EMPLOYER

SEAL AND STAMP

(FOR OFFICE USE)

Office of the Registering Officer appointed under the Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996 and Central Rules made thereunder.

Date of receipt of application:

FORM II

(SEE RULE 24[1])

OFFICE OF THE REGISTERING OFFICER

No. Date:.........................

A Certificate of Registration is hereby granted under Sub-section (3) of Section 7 of the Building and Other Construction Work (Regulation of Employment and Conditions of Service) Act, 1996 and the rules made thereunder, to M/s.... having the following particulars subject to conditions laid down in the Annexure:

Postal Address/location where building or other construction work is to be carried on by the Employer.
Name and address of employer including location of the building and other construction work.
Name and permanent address of the establishment.
Nature of work in which building workers are employed or are to be employed.
Maximum number of building workers to be employed on any day by the employer.
Probable date of commencement and completion of work.
Other particulars relevant to the employment of building workers.

SIGNATURE OF REGISTERING OFFICER WITH SEAL

ANNEXURE

THE REGISTRATION GRANTED HEREIN ABOVE IS SUBJECT TO THE FOLLOWING CONDITIONS, NAMELY -

the certificate of registration shall be non-transferable;
the number of workmen employed or building workers in the establishment shall not, on any day, exceed the maximum number specified in the certificate of registration;
save or provided in these rules, the fees paid for the grant of registration certificate shall be non-refundable;
the rates of wages payable to building workers by the employer shall not be less than rates prescribed under the Minimum Wages Act, 1948 (II of 1948) for such employment where applicable, and where the rates have been fixed by agreement, settlement or award, not less than the rates so fixed; and
the employer shall comply with the provisions of the Act and the rules made thereunder.

FORM III

[SEE RULE 24(2) AND 25(2)]

REGISTER OF ESTABLISHMENTS

S.N	Registration No. and date	Name and address location of the establishment registered where a building or other construction work is to be carried on	Name of the employer and his address	Nature of building or other construction work	Name and permanent address of Establishment	Probable date of commencement of work	Maximum No. of building workers to be employed on any day	Probable duration of building or other construction work & probable date of completion	Remarks
1	2	3	4	5	6	7	8	9	10

FORM IV

[SEE RULE 26(3) AND 239(1)]

NOTICE OF COMMENCEMENT/COMPLETION OF BUILDING OR OTHER CONSTRUCTION WORK

Name and address (Permanent) of the establishment
Name of the employer and address .................
Name and situation of place where the building and other construction is proposed to be carried on.
No. and date of Certificate of registration .........
Name and address of the person incharge of the construction work
Address to which the communications relating to building or other construction work may be sent.
Nature of work involved and the facilities including plant or machinery provided.
The arrangement storage of explosives if any to be used in building or other construction work.
In case the notice is for commencement of work, the approximate duration of work.

I/We hereby intimate that the building or other construction work (Name of work) having registration No........ dated............. is likely to commence/is likely to be completed with effect from............... (date)/on (date).

Signature of the Employer.

To:

The Inspector,

.............

FORM V

[SEE RULE 56 AND 74(B), SCHEDULE I]

CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF WINCHES, DERRICKS AND THEIR ACCESSORY GEAR

TEST CERTIFICATE NO.........

(A)IN CASE OF CONSTRUCTION SITE, NAME OF THE CONSTRUCTION SITE WHERE LIFTING APPLIANCES ARE FITTED/LOCATED :

Situation and Description of lifting appliances and Gear with distinguishing number or marks (if any), which have been tested, thoroughly examined

Angle to the horizontal derrick boom at which test load applied

Test load applied

Safe working load at the angle shown in Column (2)

Name and address of public service, association, company, or firm or testing establishment making the test and examination

Name and position of the Competent Person of public service, association, company or firm or testing establishment

(Degrees)

(Tonnes)

I certify that on the ........... day of 19.... the lifting appliance shown in Col. (1) together with its necessary gear was tested in the manner set forth overleaf in my presence that a careful

examination of the said lifting appliances after the test showed that it had withstood the test load without injury or permanent deformation and that the safe working load of the said lifting appliance and accessory gear is as shown in Column (4).

Signature of the Competent Person

Date ...................

Seal

Registration/Authority number of the Competent Person.

FORM VI

[SEE RULE 56 AND 74(B)]

CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF CRANES OR HOISTS AND THEIR ACCESSORY GEAR

Test Certificate No.........

(a)Name of the construction site where cranes or hoists are fitted/located:

STATION & DESCRIPTION

FOR JIB CRANES RADIUS AT THE TEST LOAD WAS APPLIED

TEST LOAD APPLIED

SAFE WORKING LOAD FOR JIB CRANES AT RADIUS SHOWN IN COLUMN (2)

NAME AND ADDRESS OF PUBLIC SERVICE, ASSOCIATION OR FIRM OR TESTING ESTABLISHMENT MAKING THE TEST AND EXAMINATION

NAME AND POSITION OF THE COMPETENT PERSON OF PUBLIC SERVICE, ASSOCIATION, COMPANY OR FIRM OR TESTING ESTABLISHMENT

2(DEGREES)

3(TONNES)

4(TONNES)

I certify that on the ........... day of ........... the above lifting appliances together with its accessory gear, was tested in the manner set forth overleaf that a careful examination of the said lifting appliance and gear after the test showed that it had withstood the test load without injury or permanent deformation; and the safe working load of the said lifting appliance and gear is as shown in column (4).

Signature of the Competent Person

(See note 3)

*Seal Date

Registration/Authority number of the Competent Person.

FORM VII

[SEE RULE 70 AND 74(B)]

CERTIFICATE OF INITIAL AND PERIODICAL TEST AND EXAMINATION OF LOOSE GEARS

Test Certificate No.........

(a)Name of the construction site where loose gears are fitted/ located :

DISTINGUISHING NUMBER OR MARK DESCRIPTION, DIMENSION AND MATERIAL OF GEAR/DEVICE NUMBER TESTED DATE OF TEST TEST LOAD APPLIED (TONNES) SAFE WORKING LOAD (SWL) (TONNES)

1 2

(DEGREES) 3

(TONNES) 4

(TONNES) 5 6

NAME AND ADDRESS OF MANUFACTURER OR SUPPLIERS INITIAL TEST AND EXAMINATION CERTIFICATE NO. AND DATE (ONLY IN CASE OF PERIODICAL TEST AND EXAMINATION) NAME AND ADDRESS OF PUBLIC SERVICE ASSOCIATION, COMPANY OR FIRM OR TESTING ESTABLISHMENT MAKING THE TEST AND EXAMINATION NAME AND POSITION OF THE COMPETENT PERSON OF PUBLIC SERVICE, ASSOCIATION, COMPANY OR FIRM OR TESTING ESTABLISHMENT

7 8 9 10

I certify that on the.......... day of.............19........ the above gear was tested and examined in the manner set forth overleaf; that the examination showed the said gear/device withstood the test load without injury or deformation; and that the safe working load of the said gear/ device is as shown in column 6.

Signature of the Competent Person

*Seal Date

Registration/Authority number of the Competent Person.

FORM VIII

[SEE RULE 62 AND 74(B)]

Certificate of test and examination of wire rope before being taken into use

Test Certificate No.........

(1) Name and address of maker or supplier :

(2) (a) Circumference/diameter or rope

(b) Number of strand

(d) Lay

(e) Core

(3) Quality of wire (e.g. Best Plough steel)

(4) (a) Date of test of sample of rope

(b)Load at which sample broke (tonnes)

(d) Intended use

(5) Name and address of public service, association, company or firm or testing establishment making the test and examination.

(6) Name and position of Competent Person in public service, association, company or firm or testing establishment making the test and examination.

I certify that the above particulars are correct, and that the test and examination were carried out by me and no defect effecting its safe working load (SWL) were found.

Signature of the Competent Person Seal Date

Registration/Authority number of the Competent Person.

FORM XI

[See rule 72 and 74(b)]

Certificate of Annealing of Loose Gears

Test Certificate No.........

(a) Name of the Construction site where loose gears are fitted/ located :

Distinguishing number or mark Description of gear Number of the certificate of test & examination Number annealed Date of annealing Defects found at careful inspection after annealing Name and address of public service association, company or firm or testing establishment carrying out the annealing and inspection Name and position of the Competent Person of public service, association, company or firm or testing establishment

1 2 3 4 5 6 7 8

I certify that on the date shown in column (5) the gear described in columns (1) to (4) was effectually annealed under my supervision that after being so annealed every article was carefully inspected; and that no defects affecting its safe working condition were found other than those indicated in column (6).

Signature of the Competent Person *Seal Date

Registration/Authority number of the Competent Person.

FORM X

[See Rule 69 and 73]

Certificate Of Annual Thorough Examination Of Loose Gears Exempted From Annealing

Test Certificate No.........

(a) Name of the Construction Site where loose gears are fitted/ located:

Distinguishing number or mark Description of gear Number of the certificate of initial and periodical test and examination Remarks Name and address of public service association, company or firm or testing establishment carrying out the annealing and inspection Name and position of the Competent Person of public service, association, company or firm or testing establishment

1 2 3 4 5 6

I certify that on the ........ day of ........... 19...... the above gear described in column (2) was thoroughly examined and that no defects affecting its safe working condition were found other than those indicated in column (4).

Signature of the Competent Person *Seal Date

Registration/Authority number of the Competent Person.

FORM XI

[See rule 223 (c)]

Certificate of Medical Examination

1. Certificate Serial No........

2. Date.........................

3. Name ........................

4. Identification marks:.

5. Father's Name .............................

6. Sex..........................

7. Residence.........................son/daughter of..............................................................

8. Date of birth, if available ........ and/or certificate age ............

9.Physical Fitness

I hereby certify that I have personally examined (name) ........... son/daughter/wife of ......... residing at .....................who is desirous of being employed in building and construction work and that his/her age as nearly as can be ascertained from my examination is ......... years and that he/she is fit for employment in ............. as an adult/adolescent.

10. Reason for -

(1) refusal of certificate _______________________________

(2) certificate being revoked ___________________________

Signature/Left hand

Thumb impression of

Inspector/C.M.O.

uilding worker Signature with Seal

Medical

Note - 1. Exact details of cause of physical disability should be clearly stated.

2. Functional/productive abilities should also be stated if disability is stated.

FORM XII

(See rule 223[d])

Health Register

(In respect of persons employed in Building and other construction work involving hazardous processes.)

Name of the Construction Medical Officer/Medical Inspector

(a) Mr. _____________ From __________ to _____________

(b) Mr. _____________ From __________ to _____________

(c)

Mr. _____________ From __________ to _____________

S.No.	Works No.	Name of building worker	Sex	Age (last birthday)	Date of employment of present work	Date of leaving or transfer to other work	Reason for leaving, transfer or discharge	Nature of job or occupation	Raw material or by product handled	Date of medical examination by certifying surgeon Medical Inspector /CMO	Results of medical examination	If suspended from work, state period of suspension with detailed reasons	Certified fit to resume duty on with signature of Medical Inspector / CMO	If certificate of unfitness or suspension issued to worker
1	2	3	4	5	6	7	8	9	10	11	12	13	14	15

Signature with date of Medical Inspector/CMO

Note (i) Column- (8) Detailed summary of reason for transfer or discharge should be stated.

(ii) Column- (11) should be expressed as fit/unfit/suspended.

FORM XIII

(See rule 230[a])

NOTICE OF POISONING OR OCCUPATIONAL NOTIFIABLE DISEASES

1. Name and address of the employer :

2.Name of the building workers and : his work No., if any

3. Address of the building worker :

4. Sex and age :

5. Occupation :

6. State exactly what the patient : was doing at the time of contracting the disease

7. Nature of poisoning or disease : from which the building worker is suffering from

Date: Signature of the employer/CMO

Note.- When a building worker contracts any disease specified in Schedule XII, a notice in this form shall be sent forthwith to the Chief Inspector of Inspections of Building and Construction.

FORM XIV

(See Rule 210[7])

REPORT OF ACCIDENTS AND DANGEROUS OCCURRENCES

1. Name of the project/work

2.Location of project/work

3. Stage of construction work

4. Particulars of Employer

a. Main contractor firm/co. b. Sub-contractor's particulars

Name

Address

Phone No.

Nature of business

5. Particulars of injured person:

a. Name (First)

(Middle)

(Surname)

b. Home Address

c. Occupation

d. Status of the worker:

Casual

Permanent

e. Sex: Male Female

f. Age :

g. Experience

h. Marital status:

Married Unmarried Divorced

6. Particulars of Accident

a. Exact place where accident occurred.

b. Date c. Time :

d. What the injured person was doing at the time of accident ?

e. Weather condition

f. How long employed by you for this particular job ?

g. Particulars of equipment/machine/ tool involved & condition of the same after the accident occurred

h. Brief description of the accident

7.Nature of injuries

a. Fatal b. Non-fatal

c. If non-fatal, state precisely the nature of injuries

(Describe in detail the nature of injury, for instance fracture of right arm, sprain etc.)

d. First Aid: Given: Not Given:

e. If not, give the reasons

f. Name & designation of the person by whom first aid was given

g. If admitted to hospital,

Name of the hospital:

Address of the hospital

Phone No: Name of the Doctor

8. Mode of transport used

Ambulance Truck Divorced Taxi Private Car

9. How much time was taken to shift the injured person ?

a. If very late, state the reasons

b. How the reporting was made ?

Telephone Telegram Special Messenger Letter

c. Who visited the accident site first and what action was proposed by him?

d. What are the actions taken for the investigation of the accident by the employer ?

(Describe about photographs/video film/measurements taken etc.)

10. Particulars of the persons given witness

(a) Name Address Occupation

(b) whether temporary Permanent

Particulars in case of fatal:

Date Time

Whether registered withBuilding and other Construction Workers Welfare Board If yes, Give Reg. No.

12. Dangerous Occurrences as covered under the Regulation NO. (give details)

a. collapse or failure of lifting appliances, hoist, conveyors etc.

b. collapse or subsidence of soil, any wall, floor, gallery etc.

c. collapse of transmission towers, pipelines, bridges etc.

d. explosion of receiver, vessel etc.

e. fire and explosion

f. spillage or leakage of hazardous substances

g. collapse, capsizing, toppling or collision of transport equipment.

h. leakage or release of harmful toxic gases at the construction site.

i. failure of lifting appliance, loose gear, host or building and other construction work machinery, transport equipment etc.

13. Certificate from the Employer or authorised signatory.

I certify that to the best of my knowledge and belief, the above particulars are correct in every respect.

Place Signature

Date Designation

c.c. forwarded for information and follow-up action:

Note.- If more than one person is involved, then for each person, information is to be filled-up in separate forms.

FORM XV

(See Rule 240)

Name and address of establishment where building and other construction work is to be carried on Name and permanent address of establishment

Nature and location of work ........................

S. No. Name and Surname of workman Age and Sex Father's/ Husband's name Nature of employment/ designation Permanent home address of workman (Village and Taluk and Distt.) Local address Date of commencement of employment Signature or thumb impression of workman Date of termination of employment Reasons for termination If the building work is/was beneficiary, the date of registration as a beneficiary, the registration No. and the name of Welfare Board Remarks

FORM XVI

[See rule 241(1)(a)]

Muster Roll

Name and permanent address of establishment Name and address of establishment where building or other construction work is carried on/is to be carried on

Nature of building or other construction work Name and address of Employer

For the month of .............

S. No. Name of the building worker Father's/ Husband's name Sex Dates Remarks

FORM XVII

(See rule 241(1)(a))

Name and address of establishment where building and other construction work is to be carried on Name and permanent address of establishment

Nature and location of work ........................ Name and address of the Employer

Wage period: Monthly

S.No.

Name of workman

Serial No. in the register of workman

Designation/ nature of work done

No. of days worked

Units of work done

Daily rate of wages/ piece rate

Amount of wages earned

Basic wages Dearness allowance Overtime Other cash payments (nature of payment to be indicated) Total Deductions if any (indicate nature) Net amount paid Signature/ thumb impression of workman Initial of employer or his representative

FORM XVIII

(See rule 241(1)(a))

Form of Register of Wages-cum-Muster Roll

Name and address of establishment where building and other construction work is to be carried on on/is to be carried on Name and permanent address of establishment

Nature of building or other construction work

S.No.

S.No. in register of building workers

Name of employee

Designation/ nature of work done

Daily attendance/ units worked

Total attendance/ units of work done

Daily rate of wages/ piece rate

Amount of wages earned

8 9 10 11 12 13 14 15 16

FORM XIX

(See rule 241(1)(b))

Name and address of establishment where

building and other construction work is to be

carried on/is to be carried on Name and permanent address of building worker Name and address of the employer

Nature of building or other construction work

Date of recovery

S.No.

Name of work

Father's/ Husband's name

Designation/ nature of employment

Particulars of damage or loss

Date of damage or loss

Whether building worker showed cause against deduction

Name of person in whose presence building worker's explanation was heard Amount of deduction imposed No. of instalments First instalment Last instalment

FORM XX

(See rule 241(1)(b))

Name and address of establishment where

building and other construction work is to be

carried on/is to be carried on Name and permanent address of establishment

Nature of building or other construction work Name and address of the employer

FORM XXI

(See rule 241(1)(b))

Name and address of establishment where building and other construction work is to be carried on/is to be carried on Name and permanent address of establishment

Nature of building or other construction work Name and address of the employer

S.No.

Name

Father's/ Husband's name

Designation/ nature of employment

Wage period and wages payable

Date and amount of advance given

Purpose(s) for which advance given

No. of instalments by which advance to be repaid Date and amount of each instalment repaid Date on which last instalment was repaid Remarks

FORM XXII

(See rule 241(1)(c))

Name and address of establishment where

building and other construction work is to be

carried on/is to be carried on Name and permanent address of establishment

S.No.

Name of building worker

Father's/ Husband's name

Sex

Designation/ nature of employment

Date on which overtime worked

Total overtime worked or production in case of piece rated

Normal rates of wages Overtime rate of wages Overtime earnings Date on which overtime wages paid Remarks

FORM XXIII

(See rule 241(2)(a))

Wage Book

Name and address of Employer Name and permanent address of establishment

Name and address of establishment where building and other construction work is to be carried on/is to be carried on For the Week/Fortnight/ Month ending...........

1.No. of days worked . . .

2. No. of units worked in case of piece-rate workers . .

3. Rate of daily/monthly wages/piece-rate . . .

4. Amount of overtime wages . . .

5. Gross wages payable . . .

6.Deductions, if any, on account of the following:

(a)fines

(b) damage or loss

(d) subscription towards provident fund

(e) subscription towards the fund of the Building Workers Welfare

(f) any other deductions e.g. subscriptions to Co-operative Society or account of loans from Co-operative Society/ housing loan, or contribution to any relief fund as per provision of Clause (P) of sub-section (2) of Section 7 of the Payment of Wages Act or for payment of any premium of Life Insurance Corporation.

7. Net amount of wages paid . . .

Initials of the Employer

or his Representative

FORM XXIV

(See rule 241(2)(b))

Service Certificate

Nature and location of work : .............................

Name and address of the workman : .............................

Age or Date of Birth : .............................

Identification Marks : .............................

Father's/Husband's name : .............................

S.No. Total period for which employed Nature of work done Rate of wages (with particulars of unit in case of piece work) If the building worker was a beneficiary his registration No., date and the name of the Board Reasons/ grounds on which the employment terminated Remarks

From

Signature

FORM XXV

(See rule 242(1))

Annual Return of Employer to be sent to the Registering Officer

1. Full name and full address of the establishment of the building and other construction work (Place, Post Office, District).

2. Name and permanent address of the establishment

3. Name and address of the employer

4. Nature of building and other construction work carried on

5. Full name of the Manager or person responsible for supervision and control of the establishment.

6. Number of building workers ordinarily employed

7. Total number of days during the year on which building workers were employed

8. Total number of man days worked by building workers during the year

9. Maximum number of building workers employed on any day during the year

10. The numbers of accident that took place during the year as under :

(a) The total number of accidents.

(b) The number of accidents resulting in disablement of building workers for less than 48 hours, the number of building workers involved and the number of man-days lost.

(c) The number of accidents resulting in disablement of building workers beyond 48 hours but not resulting in any permanent partial or permanent total disablement, the number of building workers involved, and the number of man-days lost on account of such accidents.

(d) The number of accidents resulting in permanent partial or total disablement, the number of building workers involved and the number of man-days lost on account of such accidents.

(e) The number of accidents resulting in deaths of building workers and the number of resultant deaths.

The Chief Inspector or Inspectors appointed by a State Government under the Act shall direct the owners of establishments registered under this Act, to send the copies of Annual Returns submitted by the employers of registered establishments in respect of the concerned State Govt. or appropriate Govt. to the Director General of Inspections by virtue of provisions of Section 60 of the Act.

The Chief Inspector or Inspectors appointed under this Act by a State Govt. shall direct the owners of such establishments as are registered under this Act by registering officers appointed by the concerned State Govt. to send copies of the Annual Returns to the Director General by virtue of provisions of Section 60 of the Act

11. Change, if any, in the management of the establishment, its location, or any other particulars furnished to the Registering Officer in the application for Registration indicating also the dates.

Employer

Place . . . . .

Date . . . . .

FORM XXVI

(See rule 74 (b))

PART - I

Initial and periodical load test of lifting appliances and their annual thorough examination.

"Thorough examination" means a visual examination, supplemented, if necessary, by other means such as a hammer test, carried out as carefully as the conditions permit, in order to arrive at a reliable conclusion as to the safety of the parts examined, and if necessary, for such examination parts of the lifting appliances and gear shall be dismantled.

(A) Initial and periodical load test of lifting appliance

Situation and description of lifting appliances tested with distinguishing number of marks if any No. of certificate of test and examination of competent person I certify that on the date on which I have appended my signature the lifting appliance shown in Column(1) was tested and no defects affecting its safe working condition were found other than those shown in column (5) Remarks (to be signed and dated

Date and signature with seal Date and signature with seal

Annual thorough examination

I certify that on the date on which I have appended my signature, the lifting appliance shown in Column (1) was thoroughly examined and no defects affecting its safe working condition were found other than those shown in column (12)

Remarks to be signed and dated

Date and signature with seal

Note:- If all the lifting appliances are thoroughly examined on the same date it will be sufficient to enter in Column (1) "All lifting appliances". If not, the parts which have been thoroughly examined on the dates must be clearly indicated.

PART - II

Initial and periodical load test of Loose gears and Annual thorough examination

List of Loose gear:

The following classes of loose gears namely-

1.Chains made of malleable cast iron;

2.Plate link chains;

3.Chains, rings, hooks, shackles and swivels made of steel;

4.Pitched chains;

5.Rings, hooks, shackles and swivels permanently attached to pitched chains, pulley blocks, container, spreaders; trays; slings; baskets; etc. and any other similar gear.

6.hooks and swivels having screw-threaded parts or ball bearings or other case-hardened parts; and

7.Bordeaux connections.

Initial Test and periodical load test of loose gears

Distinguishing No. and marks

Description of loose gear tested and examined

No. of certificates of test and examination of competent person

I certify that on the date on which I have appended my signature, the loose gears shown in Column(1) and column (2) was thoroughly examined and no defects affecting its safe working condition were found other than those shown in column (6)

Remarks to be signed and dated I certify that on the date on which I have appended my signature, the loose gears shown in Column(1) and column (2) were thoroughly examined by me and no defects affecting their safe working condition were found other than those shown in column (10)

Remarks to be signed and dated

Date and signature with seal

PART - III

Annealing of Chains, Rings, Hooks, Shackles and Swivels (other than those exempted)

(See part - II)

12.5 mm and smaller chains, rings, hooks, shackles and swivels in general use. Other chains, rings, hooks, shackles and swivels in general use. If used with lifting appliance driven by power, must be annealed once atleast in every six months.

If used solely with lifting appliance worked by hand, must be annealed once atleast in every twelve months.

If used with lifting appliance driven by power, must be annealed once atleast in twelve months.

If used solely with lifting appliance worked by hand, must be annealed once atleast in every two years.

Note :- It is recommended though not required by rules- that annealing should be carried out in a suitably constructed furnace heated to temperature between 1100 degree and 1300 degree Fahrenheit or 600 degree and 700 degree Centigrade, for a period between 30 and 60 minutes.

Distinguishing No. or mark Description of gear annealed No. of the certificate of test and examination I certify that on the date on which I have appended my signature, the gear described in Column(1) and column (2) was effectually annealed under my supervision; that after being so annealed every article was carefully inspected and that no defects affecting its safe working condition were found other than those shown in column (7) Remarks to be signed and dated

Date and signature with seal Date and signature with seal Date and signature with seal

FORM XXVII

[See Rule 266(4)]

Application for Registration

1.Name

2.Address

3.Whether SC/ST

4.Name of Father

5.Marital Status

: (Married, Unmarried or widow)

6. Date of Birth :

7. Name, address and Register No. of the Establishment where The applicant is Working :

8.E.S.I./P.F. No.

9.Name and address of employer

10. Total Service :

11. Rate of Subscription :

12. Name of Bank and Branch, where subscription Is to be paid :

13. If the applicant is already a member of any other welfare Board, the name of such Boards and registration No. of the applicant :

The above facts are true to the best of my knowledge and information.

Place : Signature of the applicant.

Date :

Name & Signature of Employer.

FORM XXVIII

[See Rule 266(7)]

Nomination Form

I nominate the following person/persons as rightful dependants, to receive all the dues from the Fund on my behalf and in the event of my death, as rightful heirs to receive all benefits due to me.

Name & address Of Nominee/ Nominees Relationship with member Age of Nominee Amount to be given to each Nominee

Place : Name, Address Regn. No. &

Date : Address of the worker.

FORM XXIX

[See rule 274]

DELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD

FORM - XXIX

[See rule 274]

DELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD

Application No.: Fee Rs.

APPLICATION FOR HBA

1.(a)Name of the applicant :

(b) Permanent Address :

2. Date of Birth :

3.Date of retirement

4.(a) Register Number :

(b) Date of Registration :

(d) Date of first remittance :

(e) Date of last remittance :

(f) Total amount remitted :

a. Whether the membership has Ever been revived, if so Details :

(h) Details of revival

5.Purpose of advance (new construction/ Maintenance/Purchase of land with Building) :

6. Whether the applicant has a house of his own (give details) :

7. Amount of advance required :

8. Details of land property

(a) Panchayat/Town :

(b) Village :

(d) District :

(e) Area :

(f) Survey No. :

(g) Valuation of the property :

(h) Details of revival

9. Whether the applicant has received Any other loan for HBA, given Details :

10. Estimate for construction/ Maintenance of building as per plan:

11. Details of the amount raised apart From the loan :

12. Whether the applicant has received Loan previously from this Board :

DECLARATION

I hereby declare that the above statements are true and correct to the best of my knowledge and belief.

Place : Signature :

Date : Name :

Details of documents to be produced :

1. Plan and estimate (approved)

2. Encumbrance Certificate of 14 years

3. Location Certificate

4. Land tax receipt

5.Original document

6. Attested copy of ration card (Page 2,4) for maintenance application

7. Ownership of the building (for maintenance only)

8. Terminal benefit declaration

9. Attested copies of identity card and passbook

10. Title clearance certificate

11. Age certificate of the building (for maintenance only)

12. Valuation certificate of the building (for maintenance only)

13. No objection certificate from the authorities for construction

14. Declaration from the applicant that neither he/she/nor his/her spouse or children own a house (for new construction).

MORTGAGE DEED

This Deed of Mortgage is executed on this the ................................................. day of ............................... two thousand hundred and ................................... by Shri/Smt................................................................son/daughter/wife of ...............aged............residing at ...................................................................................................... ........................... village............... Taluk....................................................... District....................... and Shri/Smt............................ son/daughter/wife of Shri................... aged..................... residing at.................... village................. Taluk........... District......................... (Thereinafter called the Mortgagor/Mortgagors which expression shall include his/her/their executers, administers, legal representatives and assigns) in favour of the Delhi Building and Other Construction Workers Welfare Board established under the Building and Other Construction Workers Welfare Act and having its Chief Office at Delhi (thereinafter called 'the Mortgage' which expression shall include its successors or assigns wherever the context or meaning thereof shall so require or permit).

Whereas the Mortgagor/Mortgagors has/have applied to the Mortgage for a loan of Rs.50,000 (Rupees fifty thousand only for the construction of a house on the land, more particularly mentioned and described in the schedule hereunder written :-

AND WHEREAS on the request of the Mortgager/Mortgagors the Mortgagee has agreed to lent an advance in two instalments to be mortgager a loan of Rs.50,000 (Rupees fifty thousand only) subject to the covenants, terms and conditions herein contained and having the repayment thereof, secured in the manner hereinafter expressed.

NOW THIS DEED WITNESSETH AS FOLLOWS

1. In pursuance of the said agreement and in consideration of the sum of Rs.50,000 (Rupees fifty thousand only) now lent and advance/and paid by the Mortgagee to the Mortgagor/Mortgagors, (the receipt whereof the Mortgagor hereby admits and acknowledges) the Mortgagor/Mortgagors hereby transfers/transfer by way of simple Mortgage the immovable property, more particularly mentioned and described in the schedule hereunder written together with the building to be constructed thereon and other improvements thereon from time to time to the intent that of the said property and the building and other improvements shall remain and be charged as security for payment to the Mortgagee of the said loan amount interest and cost and the Mortgagee shall have the first charge over the same.

2. The loan amount shall be paid to the Mortgagor/Mortgagors by the Mortgagee in two instalments that the first instalment of a sum of Rs.20,000 (Rupees twenty thousand only) equal to 40% of the loan sanctioned shall be paid to the Mortgagor/Mortgagors for starting construction, that the 2 nd and final instalment of Rs.30,000 (Rupees thirty thousand only) equal to 60% of the loan shall be paid after completing the construction of roof and on starting finishing works. The construction of the building shall be completed in all respects utilizing the 2 nd instalment and certificate of completion shall be produced within two months from the receipt of last instalment.

3. The instalments shall be paid only subject to the availability of funds and the non-payment of amounts due to paucity of funds shall not entitle the Mortgagor/Mortgagors to realize any loss that he/she/they may sustain on that account from the Mortgagee.

4. The Mortgagor/Mortgagors hereby assures/assure upto the Mortgagee that he/she/they is/are the absolute owners of the property mentioned in the schedule hereto and that they are free from any encumbrance or charge of any description, whatsoever or any attachment or restraints on alienation.

5.The Mortgagor/Mortgagors shall not at any time during the continuance of this security create any Mortgage lien or charge by way of hypothecation, pledge or otherwise create encumbrance of any kind whatsoever in respect of the properties described in the schedule hereto or any part thereof, or let or lease them except with the prior permission in writing of the Chief Executive Officer, Delhi Building and Other Construction Workers Welfare Board until the whole amount with interest are fully repaid.

6.The loan shall bear interest at the rate of 5% per annum or such other higher rate of interest as may be fixed by the Mortgagee from time to time.

7.The loan shall be repaid by the Mortgagor/Mortgagors in monthly instalments at the rate as would be fixed and intimated by the Mortgagee. The first instalment becoming due on the expiry of 6 months from the date of disbursement of the first instalment, subsequent instalments shall be paid on or before the 10 th day of succeeding month for 167 months. Any interest due on the loan amount outstanding on the date of payment of an instalment shall be paid along with the instalment.

8. At the time of disbursement of the 2 nd instalment the Mortgagee shall deduct the interest and other expenses due on the 1 st instalment till the date of payment of the 2 nd instalment. If the Mortgagee pays only a part of the loan amount to the Mortgagor due to the non-availability of funds such part of the loan shall be repaid by the Mortgager in instalments at the rate as would be fixed and intimated by the Mortgagee.

9. If the Mortgagor/Mortgagors dies/die before the disbursement of the remaining instalments of the loan after having received one or more instalments of the loan and if his/her/their heir or heirs executor/executors refuses/refuse to avail of the remaining instalment and also refuses or refuse to complete the construction of the house according the approved plan and estimate within one year after the date of disbursement of the first instalment of the loan the whole loan advance with interest shall be liable to be summarily recovered by proceedings against the property movable or immovable of the deceased Mortgagor/Mortgagors under the provisions of the revenue recovery at for the time being enforced and the relevant provisions of the Delhi Building and Other Construction Workers Welfare Rules, as if some were arrears of public revenue due on land or in such other manner as the Mortgagee may deem fit.

10. If the heir/heirs executors of the deceased Mortgagor/ Mortgagors does/do not require the balance instalments of the loan and are, however willing to complete the construction at her/his/their cost, the amount already paid to the Mortgagor/ Mortgagors out of the sanctioned loans will be treated as the actual amount of the loan sanctioned and the recovery shall be effective at the rate of instalment prescribed for that amount of loan.

11. The Mortgagor/Mortgagors shall remit the instalments in the Banks prescribed by the Mortgagee in the manner specified for this purpose or by the challans prescribed by the Delhi Building and Other Construction Workers Welfare Board.

12. If any instalment of principal or interest is not remitted on the due dates a penal interest at the rate of 5% in addition to the usual rates shall be paid and such amount as are not paid on due dates.

13. The Loan amount shall be utilized only for the purpose for which it is sanctioned. Each instalment of the loan referred to in Clause II above shall be utilized within the time limit prescribed. In case the Mortgagor/ Mortgagors fails/fail to claim the subsequent instalment within three months from the drawal of the previous instalments such previous instalment shall be treated as the last instalment unless the time is extended by the mortgagee and recovery shall commence as provided in the terms and conditions prescribed for the grant of the loan.

14. If the Mortgagor/Mortgagors fails/fail to utilize any instalment of loan within the maximum period admissible and does not apply for subsequent instalment of loan as provided in the conditions the entire amount already disbursed shall be recoverable from him/her/them with interest in lumpsum.

14a. If the Mortgagor/Mortgagors is/are found to have failed in utilizing the amount for the construction of house as specified in the mortgage deed within the prescribed period, the mortgagee is entitled to realize the entire loan amount plus other charges with interest in a lump after the issuance of a registered notice directing to pay the amount within a period of 30 days.

(i) If the Mortgagor/Mortgagors repay the amount due in lumpsum within the stipulated period the mortgage deed shall be released.

(ii) If the Mortgagor/Mortgagors fails/fail to repay the amount due within the period of 60 days as stipulated above the mortgagee will have the right to take step to realize the entire dues to the Board in lump. In addition to that a penalty not exceeding 5% of the loan amount actually received by the loanee or Rs.1000 (Rupees one thousand only) whichever is higher shall also be realized from the Mortgagor/Mortgagors.

15. In the event of any information furnished in the application being found false or materially incorrect, the Mortgagee shall be cancel the loan and recover the entire amount outstanding in lump with interest accrued thereon by selling the mortgaged property besides taking such legal action against the borrower as may be considered desirable.

16. The Mortgagor/Mortgagors shall not alter or modify the building constructed in accordance with the plan approved by the Mortgagee so as to diminish the value of the property or construct any other building in the property, offered as security till the entire amount with interest are repaid.

17. In case of the Mortgagor/Mortgagors at any time make default in the payment of two consecutive instalments or commits breach of all or any of the terms and conditions contained herein the balance of the principal of sum which shall for the time being remain unpaid together with interest accrued thereon and all sums found due to the Mortgagee under or by virtue of these presents shall forthwith become payable in a lump at once and in case of default of payment of the whole sum immediately the Mortgagee shall have power without the intervention of any court to take possession of the Mortgaged property and to sell the same. The balance of the sale proceeds after adjusting all amounts due to the Mortgagee will be disbursed to the Mortgagor. The Mortgagee shall also have all the powers vested in the Mortgagee under the provision of the Transfer of Property Act, 1882

18. Without prejudice to any or all of the other rights and remedies of the Mortgagee all sums found due to the Mortgagee under or by virtue of these presents shall be recoverable from the Mortgagor/Mortgagors and his/her/their properties, movable and immovable under the provisions of the Revenue Recovery Act for the time being in force as though they are arrears of Public Revenue due on land and in accordance with the relevant provision of the Delhi Building and Other Construction Workers Act in any other manner as the Mortgagee may deem fit.

19. The Mortgagor/Mortgagors shall be bound by the terms of the application form and the conditions attached thereto which shall form part of this deed as if they are incorporated on this deed.

20. This Mortgage has been fully explained to the Mortgagor/ Mortgagors and the Mortgagor/ Mortgagors has/have executed these presents fully understanding the implications thereof and all his/her/their obligations thereunder and after receiving such advice.

THE SCHEDULE ABOVE REFERRED TO

(here enter details of all land and buildings)

IN WITNESS WHEREOF Shri_______________________________, the Mortgagor(s) here to set his/her/their hands the day and year first above, written and signed by Shri/Smt.____________________ in the presence of witness :

Signed by Shri/Smt._________________________ in the presence of witnesses :

STAGE CERTIFICATE FOR RELEASE OF SECOND INSTALMENT

OF ADVANCE SANCTIONED BY THE DELHI BUILDING AND

OTHER CONSTRUCTION WORKERS WELFARE BOARD UNDER

HOUSING LOAN SCHEME

BENEFICIARY

PROPERTY

1. Reg.No.

_________________ District ___________________

2. Name _________________ Taluk __________________

3. Address _________________ Village _________________

4. Signature _______________ Sy.No. _________________

The Construction of building in the property detailed above by the beneficiary specified above has reached/completion of foundation basement and on completion work upto lintel level/ completion of the lintel work/ completion of the linter work and 50% of the work of the roof and stored the materials for the work of shutters/ completion of the roof work and has been completed 40% of the finished work as per the plan and the beneficiary is eligible for the second instalment of the loan sanctioned by the Delhi Building and Other Construction Workers' Welfare Board.

Certified that the work valued at Rs.___________ has been carried out by the beneficiary as on __________________.

Place :

Signature of District, Executive

Officer/T.E.O. or any Authorised

Date : Officer with name & designation.

Name of Office.

Appl No.: Fee Rs.

APPLICATION FOR HBA

1.(a)Name of the applicant :

(b) Permanent Address :

2. Date of Birth :

3.Date of retirement

4.(a) Register Number :

(b) Date of Registration :

(d) Date of first remittance :

(e) Date of last remittance :

(f) Total amount remitted :

a. Whether the membership has Ever been revived, if so Details :

(h) Details of revival

5.Purpose of advance (new construction/ Maintenance/Purchase of land with Building) :

6. Whether the applicant has a house of his own (give details) :

7. Amount of advance required :

8. Details of land property

(a) Panchayat/Town :

(b) Village :

(d) District :

(e) Area :

(f) Survey No. :

(g) Valuation of the property :

(h) Details of revival

9. Whether the applicant has received Any other loan for HBA, given Details :

10. Estimate for construction/ Maintenance of building as per plan:

11. Details of the amount raised apart From the loan :

12. Whether the applicant has received Loan previously from this Board :

DECLARATION

I hereby declare that the above statements are true and correct to the best of my knowledge and belief.

Place : Signature :

Date : Name :

Details of documents to be produced :

1. Plan and estimate (approved)

2. Encumbrance Certificate of 14 years

3. Location Certificate

4. Land tax receipt

5.Original document

6. Attested copy of ration card (Page 2,4) for maintenance application

7. Ownership of the building (for maintenance only)

8. Terminal benefit declaration

9. Attested copies of identity card and passbook

10. Title clearance certificate

11. Age certificate of the building (for maintenance only)

12. Valuation certificate of the building (for maintenance only)

13. No objection certificate from the authorities for construction

14. Declaration from the applicant that neither he/she/nor his/her spouse or children own a house (for new construction).

MORTGAGE DEED

NOW THIS DEED WITNESSETH AS FOLLOWS

1.In pursuance of the said agreement and in consideration of the sum of Rs.50,000 (Rupees fifty thousand only) now lent and advance/and paid by the Mortgagee to the Mortgagor/Mortgagors, (the receipt whereof the Mortgagor hereby admits and acknowledges) the Mortgagor/Mortgagors hereby transfers/transfer by way of simple Mortgage the immovable property, more particularly mentioned and described in the schedule hereunder written together with the building to be constructed thereon and other improvements thereon from time to time to the intent that of the said property and the building and other improvements shall remain and be charged as security for payment to the Mortgagee of the said loan amount interest and cost and the Mortgagee shall have the first charge over the same.

2.The loan amount shall be paid to the Mortgagor/Mortgagors by the Mortgagee in two instalments that the first instalment of a sum of Rs.20,000 (Rupees twenty thousand only) equal to 40% of the loan sanctioned shall be paid to the Mortgagor/Mortgagors for starting construction, that the 2 nd and final instalment of Rs.30,000 (Rupees thirty thousand only) equal to 60% of the loan shall be paid after completing the construction of roof and on starting finishing works. The construction of the building shall be completed in all respects utilizing the 2 nd instalment and certificate of completion shall be produced within two months from the receipt of last instalment.

3.The instalments shall be paid only subject to the availability of funds and the non-payment of amounts due to paucity of funds shall not entitle the Mortgagor/Mortgagors to realize any loss that he/she/they may sustain on that account from the Mortgagee.

4.The Mortgagor/Mortgagors hereby assures/assure upto the Mortgagee that he/she/they is/are the absolute owners of the property mentioned in the schedule hereto and that they are free from any encumbrance or charge of any description, whatsoever or any attachment or restraints on alienation.

6.The loan shall bear interest at the rate of 5% per annum or such other higher rate of interest as may be fixed by the Mortgagee from time to time.

8.At the time of disbursement of the 2 nd instalment the Mortgagee shall deduct the interest and other expenses due on the 1 st instalment till the date of payment of the 2 nd instalment. If the Mortgagee pays only a part of the loan amount to the Mortgagor due to the non-availability of funds such part of the loan shall be repaid by the Mortgager in instalments at the rate as would be fixed and intimated by the Mortgagee.

11.The Mortgagor/Mortgagors shall remit the instalments in the Banks prescribed by the Mortgagee in the manner specified for this purpose or by the challans prescribed by the Delhi Building and Other Construction Workers Welfare Board.

12.If any instalment of principal or interest is not remitted on the due dates a penal interest at the rate of 5% in addition to the usual rates shall be paid and such amount as are not paid on due dates.

13.The Loan amount shall be utilized only for the purpose for which it is sanctioned. Each instalment of the loan referred to in Clause II above shall be utilized within the time limit prescribed. In case the Mortgagor/ Mortgagors fails/fail to claim the subsequent instalment within three months from the drawal of the previous instalments such previous instalment shall be treated as the last instalment unless the time is extended by the mortgagee and recovery shall commence as provided in the terms and conditions prescribed for the grant of the loan.

14.If the Mortgagor/Mortgagors fails/fail to utilize any instalment of loan within the maximum period admissible and does not apply for subsequent instalment of loan as provided in the conditions the entire amount already disbursed shall be recoverable from him/her/them with interest in lumpsum.

(i)If the Mortgagor/Mortgagors repay the amount due in lumpsum within the stipulated period the mortgage deed shall be released.

(ii)If the Mortgagor/Mortgagors fails/fail to repay the amount due within the period of 60 days as stipulated above the mortgagee will have the right to take step to realize the entire dues to the Board in lump. In addition to that a penalty not exceeding 5% of the loan amount actually received by the loanee or Rs.1000 (Rupees one thousand only) whichever is higher shall also be realized from the Mortgagor/Mortgagors.

19. The Mortgagor/Mortgagors shall be bound by the terms of the application form and the conditions attached thereto which shall form part of this deed as if they are incorporated on this deed.

THE SCHEDULE ABOVE REFERRED TO

(here enter details of all land and buildings)

Signed by Shri/Smt._________________________ in the presence of witnesses :

STAGE CERTIFICATE FOR RELEASE OF SECOND INSTALMENT

OF ADVANCE SANCTIONED BY THE DELHI BUILDING AND

OTHER CONSTRUCTION WORKERS WELFARE BOARD UNDER

HOUSING LOAN SCHEME

BENEFICIARY

PROPERTY

1. Reg.No.

2. _________________ District ___________________

3. Name _________________ Taluk __________________

4. Address _________________ Village _________________

5. Signature _______________ Sy.No. _________________

Certified that the work valued at Rs.___________ has been carried out by the beneficiary as on __________________.

Place :

Signature of District, Executive

Officer/T.E.O. or any Authorised

Date : Officer with name & designation.

Name of Office.

FORM XXX

[See Rule 268(2)]

DELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD

Name and Address of the Establishment :

Sl. No. No.of workers as on the Close of Previous Month No. & Name(s) of worker(s) who left service during the month No. & Name(s) of worker(s) to be registered No.of workers as on the Close of Current Month

Place :

Date : Name & Signature of the Employer

(Office Seal)

FORM XXXI

[See rule 268 (3)]

DELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD

Particulars of Establishment

1. Name of the Establishment :

2. Nature of Establishment Whether Company/ Partnership Firm/sole proprietorship :

3.Names of the partners/ Directors/Proprietor

4. Name of Managing Partner/ Managing Director/ Person Who is in ultimate control of The establishment :

5.Details of branches :

6. Details of occupiers :

Place : Name, Signature and Designation

Date :

(Office Seal)

PAGE-I

PHOTO

Signature, date and official

Designation of the registering

Authority (with office seal)

PAGE-II

Name of Member :

Address

Male/Female

Name of job

Registration No.

District

Date of Registration

Name of Bank & Branch in Which subscription is to Be paid

Subscription rate : Rs.20 :

PAGE-III

Date of birth :

Completed age

Date of retirement

Marital status

Married/Unmarried

Name of Wife/Husband

Address

Whether wife/husband, a

Member of this Board

: Yes/No

If so, name and registration

Number

Name of Nominees

Relationship with the member

Signature/Thumb impression

Of the member

Official designation and

Signature of registering

Authority.

FORM XXXIII

[See Rule 266(8)]

Name of district _________________

Sl. No.

No.of dentity Cards

Date

of issue

Name and address Of the Worker

Signature of District Executive Officer

Remarks

FORM XXXIV

[See rule 271]

APPLICATION FOR MATERNITY BENEFIT

1.Name and address of applicant

2.Registration No.

3.Age and date of birth

4.Name of husband

5.Date of confinement

6.Have you applied for this benefit earlier

7.If so how many times and give details

8.Date of registration

9.Date of payment of 1st subscription and amount

10.Date of payment of last subscription

11.Name of bank and place

12.List of Documents submitted

(a) Copy of Challans or Copy of pass book

(b) Medical certificate in original.

The facts furnished above are true to my knowledge and information.

Place : Name and Signature of applicant

Date :

FORM OF MEDICAL CERTIFICATE

(To be obtained for a Medical Officer not below the rank of an Assistant Surgeon)

I Have examined Smt._________________________________________

age_____________ and wife of Shri ___________________________________ she

is pregnant running _____________________ month. She had delivered a child on

___________________.

Place : Name of Doctor & Seal.

Date :

FORM XXXIV

[See rule 273(1)]

PLICATION FOR PENSION

FORM - XXXV

[See rule 273(1)]

APPLICATION FOR PENSION

1. Name and Address of applicant

2.Registration No.

3.Date of completion of 60 years

4.Date of payment of 1st subscription amount and Name of Bank

5.Default if any and reasons thereof

6.Date of payment of last subscription amount, date and name of Bank.

7.List of documents

(a)Identity Card

(b)Pass Book

(c)Challans

8. Address at which pension is to be sent

9. Any other information (Details of benefit if any, from other welfare Boards)

The facts furnished above are true to my knowledge and information.

Place : Name and Signature of applicant

Date :

FORM XXXVI

[See rule 273(6)]

PPO No.

Name & address of the pensioner with Membership No. in The D.B.O.C.W.W. Board

Date of Birth

-------------- Date of entry in the scheme

Date of retirement

Total Service

(1) No. & date Of Order

(2) of sanctioning Authority

(3) Date of

(4) commencement of pension

(5) Monthly Rate of pension

Rs.

Deated-initial of

---------------- Secretary D.E.O.

Remarks Order on cancellation of pension etc. May be noted here with reason and date Effect under initials of Secretary/DEO

(6) Details of Pension Paid

(7) Month/Year

(8) Amount of pention

(9) Date of sending of Money Order

(10) Dated initials if D.E.O./S.S.

(11) Remarks (Details of undelivered H.O. etc. may be noted here

FORM XXXVII

[See rule 279(1)]

APPLICATION FOR DEATH BENEFIT

1.Name and Address of applicant

2.Relationship with worker

3.Name and address of the worker

4.Registration No.

5.Age & Date of Birth

6.Worker whether married

7.Nature of Death (Give details)

8.Details of documents submitted

9.Amount of financial assistance applied for

The facts furnished above are true to my knowledge and information.

Place : Name and Signature

Date :

FORM XXXVIII

[See rule 279(4)]

Sl. No. Date of receipt of application Name and Register No. of worker Period of remittance Date of death

Order No. and date

Name & Address Of nominee with Relationship to Member

Amount of Death Benefit

Refund of Amount

Total

Initial

FORM XXXIX

[See rule 275(2)]

APPLICATION FOR DISABILITY PENSION

1. Name and address of applicant

2.Age and Date of Birth

3.Registration No.

4.Date of payment of first subscription amount and Name of Bank & Branch

5. Date of payment of last subscription amount and Name of bank

6. Total amount of subscription

7. Details of disease/accident

8.Nature of disability due to disease/accident

9.Details of treatment in Government hospitals Date of admission and date of discharge.

10. Whether the patient was in plaster? If so, for how any days?

11.Amount spent for treatment (should be supported by medical bills countersigned by the treating doctor)

12. List of documents submitted

13. Details of benefits received, if any before.

14.Details of benefits received, if any from Government or any other institution, for the above treatment.

The facts furnished above are true to my knowledge and information.

Place : Name and Signature of Applicant.

Date :

FORM XL

[See rule 276]

APPLICATION FOR INSTRUMENT LOAN

1.Name of the Applicant

2.Father's/Husband's Name

3.Residential Address

4.Register No.

5.Name of Bank in which contribution remitted

6.Age & Date of Birth

7.Monthly Income

8.Details of other properties if any, owned or possessed by the applicant

9.DETAILS OF SURETIES

Name & Address

Occupation & Address

Age & Date of birth

Present net monthly income

Details of other properties Owned/possessed by the surety

Whether the surety has offered Himself as surety for any other Transaction earlier, if so, The details

10.Whether salary certificate from the employer is attached.

11.PARTICULARS OF INSTRUMENTS TO BE PURCHASED

(a)Description

(b)Make

(c)Model

(d)Invoice price (copy enclosed)

(e)Name & Address of supplier/dealer

12. (a)Amount of loan applied for

(b)No. of monthly instalments proposed for repayment

DECLARATION

A.I/We confirm that the funds will be used for the stated purpose only and will not be used for speculation and/or anti-social purpose.

B.I/We understand that the Board has the right to recall the funds if they are not used for the stated purpose.

C. I/We understand that the sanction of the facility is at the discretion of the Board and I/we will execute necessary Security Documents as per the Board's requirements to its satisfaction.

Place : Name and Signature of Applicant.

Date :

Surety 1. Name & Signature.

(For Office Use only)

The application submitted by Shri__________________ employed as _________________________________ in _______________ has been verified. The certificate of employment and surety in respect of the borrower/surety has been attached along with the undertaking by the employer.

An amount of Rs.________________ (Rupees _______________________________________________________) may be sanctioned for the purpose being the amount requested/amount eligible 75% of the invoice amount to be recovered of Rs._______________ (Rupees __________________________________________) in ________________ equal monthly instalments. The last instalment will be the amount outstanding after remittance of the ______________________ instalment including other dues to the Board at the time of closing of the loan amount.

Sanctioned/Rejected

District Executive Officer.

Secretary

DELHI BUILDING AND OTHER CONSTRUCTION WORKERS WELFARE BOARD (GOVERNMENT OF N.C.T. OF DELHI )

Certified that Shri/Smt. _______________________ S/o, D/o, W/o _____________________________ of __________________ House No. _________________ Town _________________ Desam _________________ Village __________________ Taluk _____________ District ____________________ now residing at House No.___________________ Town/Desam ____________________ Village ____________________ Taluk __________________District _________________ is a permanent/officiating/acting/provisional ___________________________ (Designation).

DETAILS OF HIS/HER SERVICE ARE AS UNDER

1.Date of entry into service

________________________________

2. Date of which continuous service beings ___________________

Date of retirement ______________________________.

DETAILS OF HIS/HER PAY, ETC. ARE AS UNDER

1. Basic Pay __________________ (a)

Provident Fund

___________

2. Dearness Allowance __________ (b) LIC recoveries ___________

3. HRA __________________ (c) Income Tax _______________

4. Compensatory Allowance _______ (d) Loan recoveries

1. ___________

2. ___________

3. ___________

5. Other Allowances ____________ (e) Other recoveries

1.________

2. ________

TOTAL (A) _______________ TOTAL (B) ____________

NET SALARY : A) - (B) Rs. ______________

Place :

Signature

Date : Name

(Office Seal)

Designation of the

Head of Office/Department

UNDERTAKING FOR RECOVERY FROM PAY

FORM XLI

[See rule 277]

APPLICATION FOR FUNERAL BENEFIT

1.Name & Address of Applicant

2.Relationship of applicant with the worker

3.Name and address of worker

4.Registration No.

5.Date of registration

6.Date of payment & first subscription, amount and name of bank, branch.

7.Date of payment of last subscription, amount, name of bank, branch.

8.Duration of membership

9.Whether membership was live ?

10.Date of death of the worker

11.Reason for death

12.Whether applicant is the nominee of the worker

13.If not, whether the applicant has submitted ependence certificate.

14.Name, age & date of birth of the nominee

15.If nominees are minor, name of guardian and his relationships with the children

16.Whether consent letters from other nominees ubmitted ? (Where the No. of nominees is more than one)

17.Whether certificate of guardianship submitted by the minor children

18.Amount of benefit, applied for

The facts furnished above are true to my knowledge and information.

Place : Name and Signature of Applicant.

Date :

FORM XLII

[See rule 280]

APPLICATION FOR MEDICAL BENEFIT

1.Name and address of applicant

2.Age and date of birth

3.Registration No.

4.Date of payment & first subscription, Amount and name of bank

5.Date of payment of last subscription, Amount, and Name of bank

6.Total amount remitted

7.Details regarding disease/ surgery

8.Disability if any, due to disease or surgery

9.Period of treatment as patient in Government Hospitals (Date of admission in the Hospital and date of discharge)

10.List of documents submitted

11.Details of medical benefits received, if any before

The facts furnished above are true to my knowledge and information.

Place : Name and Signature of Applicant.

Date :

FORM XLIII

[See rule 281]

APPLICATION FOR EDUCATIONAL SCHOLARSHIP

1.Name of student

2.Male/Female

3.(a) SC/ST

(b)Whether proof is attached

4.Name of college and affiliated University/Board

5.Name and year of course

6.Date of admission to the course

7.Age & Date of birth of the student

8.Details of qualifying examination passed

Name of Exam qualifying

Name of affiliated University /Board/ State

Month & Year of passing examination

9.Marks scored in the qualifying examination

Maximum marks

Subject

Marks Scored

Maximum marks

Percentage

Total Marks

10.(a) Name of parent of applicant

(b) Registration No.

(d) Date of payment of last subscription

(e) No. of instalments paid

Total subscription paid

(f) Permanent address

(g) Has the membership been revived

Yes/No

If so, period of revival

The facts mentioned above are true to my knowledge. If selected for the scholarship, I promise that I will abide by the condition stipulated in the Scheme.

Place : Name & Signature of the student.

Date :

Affidavit of the Parent of the Student

I (Name and address) S/o or D/o (Name and address) __________________ solemnly affirm the following :

1.My son/daughter Shri/Smt._________________________ is studying for ____________________ (name and years of course).

2.I am a member of the Board since _____________________(Year) with registration No.

3.subscription has been paid upto ________________________.

4. If any of the above facts are found to be wrong later, the scholarship amount granted to the student will be remitted back by me. The decision of Secretary in this regard will be applicable to me and it will be final and I agree with the same.

5. I also agree to recover any amount of default due from me.

Place : Name & Signature of the student.

Date :

(To be signed before MLA/MP/Panchayat President/Gazetted Officer of State or Central)

I certify that Smt./Shri______________________ who has signed above has put the signature in my presence.

Place :

Attesting Officer

Date : Name

(Seal)

Official designation

I ____________________ Head of ___________ __________(Name of institution) hereby certify that Smt./Shri ____________________________ is a _____________year student of ____________________course. I have examined the application submitted by the student and I am convinced that it is correct. This institution is affiliated to the ________________university/Board.

Place :

(Office Seal)

Signature of Principal/ Head

Date : Name

Official designation

ENQUIRY REPORT OF DISTRICT EXECUTIVE OFFICER

1. Shri/Smt.______________________ is a live member of this Board, having registration No.______________________ and is paying subscription regularly.

2. He has paid subscription regularly from ______________ to _________________. He has not defaulted payment of subscription. Membership has been revived for the period from _____________ to _______________. I recommend/do not recommend the application (reason for rejection).

District Executive Officer

FORM XLIV

[See rule 282]

APPLICATION FOR MARRIAGE ASSISTANCE

1. Name of Applicant

2. Address

3. Registration No.

4. Age and Date of Birth

5. Date of payment of first subscription, Amount & Name of Bank and branch

6. Date of payment of last subscription, Amount, Name of Bank and branch

7. Duration of membership

8. Is membership live?

9. If application is for the marriage of Son/Daughter

(1) Whether husband or wife, A member of this Board

(2) If so, has she/he applied For the financial assistance

(3) Date of birth of the son/ Daughter who is getting

(4) Address of the bride or bridegroom of the son/ daughter

(5) Date and place of marriage

(6) Date & No. of the Certificate of marriage

Name and address of the Authority who issued the Certificate

(7) Have you applied for financial assistance for the marriage of any other son/daughter; if so, details of the same.

10. If application is for the Marriage of self (for women worker only)

(1) Name and address of Husband/bridegroom

(2) Date & place of marriage

(3) No. & Date of the Certificate of marriage

Name and address of the Authority who issued the Certificate

11. Are you in receipt of any financial assistance for the purpose from Government or any other institution

The above facts are true to the best of my knowledge and information.

Place : Name & Signature of the applicant.

Date :

FORM XLV

[See rule 283]

APPLICATION FOR FAMILY PENSION

FORM - XLV

1.Name and address of applicant

2.Address of the pensioner/worker

3.Relationship with worker

4.Date of death of the worker

5.Monthly pension received by the worker

6.Whether applicant is receiving pension from Government /Semi-Government or any other Institution? If yes, details Thereof

7.Whether applicant is receiving salary from Government/ Semi-Government/private institutions ? If yes, details thereof

8.List of documents submitted

The above facts are true to the best of my knowledge and information.

Place : Name & Signature of the applicant.

Date :

List of documents to be submitted alongwith application

1.Death certificate of the worker.

2.Village Officer's Certificate showing relationship between the applicant and the worker.

3.Village Officer's certificate stating that the applicant is not receiving any pension from Government/Semi-Government/Private Institution.

4.Village Officer's Certificate stating that the applicant is not receiving any salary from Government/Semi Government/ Private Institutions.

FORM XLVI

[See rule 280]

APPLICATION FOR EXGRATIA MEDICAL ASSISTANCE FOR ACCIDENTS

1.Name and address of applicant

2.Date of death of Birth

3.Registration No.

4.Date of payment of first subscription, amount, Challan No. and Name of Bank, Branch.

5.Date of payment of last subscription, Challan No., amount, name of Bank, branch.

6.Total amount of subscription

7.Details regarding accident

8.Nature of disability due to accident.

9.Whether treated in Government hospital? If so, date of admission and date of discharge.

10.Whether the applicant was in plaster? If so, for how many days

11.Details of documents submitted

12.Financial assistance applied for

13.Have you received any financial assistance for treatment before? If yes, give particulars.

The above facts are true to the best of my knowledge and information.

Place : Name and Signature of applicant

Date :

BY ORDER AND IN THE NAME OF THE LT. GOVERNOR OF THE NATIONAL CAPITAL TERRITORY OF DELHI

Copy to :-

1.The Dy. Secretary, General Administration Department (in duplicate) for favour of publication in the Delhi Gazette Extra-ordinary of today's date. It is requested to kindly send 10 copies of the Gazette for official use.

2.The Secretary to the Lt. Governor, Government of Delhi , Raj Niwas, Delhi .

3.Secretary to the Government of India , Ministry of Labour, Sharam Shakti Bhawan, New Delhi .

4.Secretary to the Minister of Labour, Government of Delhi , Old Secretariat, Delhi .

5.P.S. to Chief Secretary, Government of National Capital Territory of Delhi of Delhi , Delhi .

6.Secretary (Law & Judicial), Government of Delhi , Delhi .

7.Labour Commissioner, Government of National Capital Territory of Delhi OF Delhi , 5, Shamnath marg, Delhi .

8.J.Labour Commissioner's/D.Labour Commissioner's/A.Labour Commissioner'S and Labour officer.

9.The Editor, Shram Patrika, Labour Department, Delhi .

10. Asstt. Director (P&S), Labour Department, 5, Shamnath marg, Delhi .

11. Librarian/Guard File, Labour Department, Delhi .

(K.R.SAWHNEY) UNDER SECRETARY (LABOUR)

GOVERNMENT OF N.C.T. OF DELHI

Labour Commissioner
Government of NCT of Delhi