© [Regd. No. TN/CCN/467/2012-14. GOVERNMENT OF TAMIL NADU [R. Dis. No. 197/2009. 2012 [Price: Rs. 1.60 Paise. TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY PUBLISHED BY AUTHORITY No. 17] CHENNAI, TUESDAY, JANUARY 24, 2012 Thai 10, Thiruvalluvar Aandu–2043 Part II—Section 2 Notifications or Orders of interest to a section of the public issued by Secretariat Departments. NOTIFICATIONS BY GOVERNMENT LABOUR AND EMPLOYMENT DEPARTMENT AMENDMENTS TO THE TAMIL NADU MANUAL WORKERS (CONSTRUCTION WORKERS) WELFARE SCHEME, 1994. [G.O. Ms. No.17, Labour and Employment (I2), 24th January 2012.] No. II(2)/LE/32(c)/2012. In exercise of the powers conferred by Section 4 of the Tamil Nadu Manual Workers (Regulation of Employment and Conditions of Work) Act, 1982 (Tamil Nadu Act 33 of 1982), the Governor of Tamil Nadu hereby makes the following Amendments to the Tamil Nadu Manual Workers (Construction Workers) Welfare Scheme, 1994:— AMENDMENTS In the said Scheme,- 1. in clause 13,- (1) after sub-clause (1), the following sub-clause shall be added, namely:- “(1-A) Family Pension.— Every registered manual worker who is in receipt of pension dies, the spouse of such manual worker is eligible for family pension of Rs.400/- (Rupees four hundred only).”; (2) in sub-clause (2)- (i) after item (a), the following item shall be inserted namely:— “(aa) The spouse of the manual worker, who is eligible for family pension under sub-clause (1-A), shall apply in Form-CCC to the Labour Officer (Social Security Scheme) of the respective district: Provided that he should produce death certificate of the deceased registered manual worker and the legal heir certificate issued by the Revenue Department.”; (ii) in item (b),- (a) after the expression “application for pension”, the expression “or family pension” shall be inserted; (b) after the expression “claim for pension”, the expression “or family pension” shall be inserted; (2) after Form-CC, the following Form shall be inserted, namely:— DTP—II-2 Ex.2—(17) [1] 2 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY “FORM – CCC’ [See clause 13(2)(aa)] APPLICATION FOR FAMILY PENSION To Passport Size photograph The Labour Officer (Social Security Scheme) duly signed ………………… District. 1. Name of the Applicant : 2. Name of the Deceased Pensioner : 3. Relationship of the applicant with the Deceased Pensioner (Attested Legal Heir Certificate should be enclosed) : 4. Address of the Applicant in full (to which Family Pension is to be sent) (with PIN code) : 5. Date of death of Deceased Pensioner (Attested Death Certificate should be enclosed) : 6. Applicant’s age and date of birth : 7. Whether the applicant is the dependant of the Deceased Pensioner : 8. Pension Order No. and Date vide which the deceased was drawing Pension : 9. Whether the applicant is in receipt of any other Pension? If so, furnish complete details. : Signature of the Applicant. DECLARATION** I hereby declare that the facts mentioned above are true to the best of my knowledge and information. If ultimately it is found that any of the information given by me is false, I agree to refund the entire amount received by me as family pension besides any other action that may be deemed fit by the appropriate authorities. I also hereby declare that I have not received similar benefits by claim in any other Welfare Board or Boards constituted by the Government of Tamil Nadu or under any other Government Schemes including Old Age Pension sanctioned by the Government. Place: Signature/Thumb Impression Date: Name : **Any false declaration / certification will entail legal action. Note : 1. Besides the photograph affixed above another passport size photograph should be enclosed with the application. 2. Attested Death Certificate 3. Copy of Pension Order of the Deceased 4. Incomplete applications will not be considered. 5. Attested Legal Heir Certificate. TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 3 SANCTION I hereby sanction, after due verification including the verification of beneficiaries list of the Old Age Pension maintained in Revenue Department, a monthly Family Pension of Rs.400/- (Rupees four hundred only) with effect from ................................................The amount shall be sent by Money Order. Place: Labour Officer (Social Security Scheme) ......................................District. Date: ACKNOWLEDGEMENT SLIP Received Application form from Thiru/Tmt. ………………… Wife of / Husband of the Deceased Pensioner Shri/Smt……………………..who was residing at …………………………………………………………(Address in full) (Registration No. of Deceased Pensioner ……………..) for sanction of family pension. Signature with date Labour Officer (Social Security Scheme), ......................................................District. Name: Office Seal : ". MOHAN PYARE, Principal Secretary to Government. PRINTED AND PUBLISHED BY THE DIRECTOR OF STATIONERY AND PRINTING, CHENNAI ON BEHALF OF THE GOVERNMENT OF TAMIL NADU