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SOUTH CENTRAL RAILWAY

SUPPLEMENTARY GAZETTE ON

STAFF BENEFIT FUND

2011-12

SOUTH CENTRAL RAILWAY HEADQUARTERS STAFF BENEFIT FUND

Headquarters Office,Personnel Branch,

Secunderabad–500 071.

STAFF BENEFIT FUND – SCHEMES ADOPTED FOR THE F Y 2011-12

No. SCR/P-HQ/456/17 – Subject to modification from time to time and availability of funds, the schemes approved by the South Central Railway HQ SBF Committee for the FY 2011-12 are enumerated in this booklet. The Staff Benefit Fund is managed by a Committee comprising the following:

S.No. Designation of the Officer Position in the HQ SBF Committee

01 Chief Personnel Officer Chairman

02 Chief Personnel Officer(IR) Vice-Chairman

03 Dy. Chief Personnel Officer (W & IT)

Secretary

04 Principal Chief Engineer (Open Line)

Member from the Official Side

05 Chief Medical Director Member from the Official Side

06 Representative from Accounts Dept – To be nominated by the FA & CAO/SC

Member from the Official Side

In addition to the above, the following members represent the recognized labour on the Committee:

S.No. Name & Designation of the representative

Organization represented

Mobile Number of the representative

01 S.Sreedhar, O.S-I, CCM/O/SC

SCRMU 9346666024

02 G.Uday Bhasker Rao, O.S.II, COS/O/SC

SCRMU 9866199714

03 P.S.Charan GSR/BZA DS/SCRMU/BZA (on deputation)

SCRMU 9848150135

04 Ch.Hari, COS, GM/STT/O/SC

SCRES 9908694283

05 M.Bharani Bhanu Prasad, O.S.II, PCE/OL/O/SC

SCRES 9848545044

06 G.Mohan Rao, O.S.I, Dy.CMM(G&S)/MFT

SCRES 9705168651

The South Central Railway Central Staff Benefit Fund provides the following benefits to its Group ’C’ & ‘D’ employees:

A. EDUCATION:

S.No Scheme Eligibility Amount of

grant eligible

Application to be made

In Proforma

EDUCATION01 Advance for

prosecuting Correspondence Courses

All Group ‘C’ & ‘D’ employees prosecuting a correspondence course offered by:B.I.E.T.Mumbai/ICWA Kolkata/Institute of Rail Transport and Management/NDLS / Technical Education & Material Management in the evening colleges

Limited to the amount of Fee payable.

‘A’

02 Scholarship for Technical Education -Degree courses

Wards of Railway employees pursuing any of the following degree coursesM.B.B.S/B.D.S/B.V.Sc/BHMS/or MBS/BAMS/BUMSB.E., B. Tech., B.Arch., Bachelor in Environment Planning/ CA / ICWA MCA, BCA, MBAM.Sc- All BranchesB. Pharmacy, BPT B.Sc - Agriculture, Home Science, Computers, Bio-Technology, IT, Horticulture, Nursing, Micro- Biology B. Com- (Computers) and Diploma courses exceeding one year duration.

Rs. 1200 per month/ Rs.14400 per annum (or) the actual fee paid whichever is lower.* ‘B’

AGirl Children of employees in GP 1800*

B

Boy Children of Railway employees in GP 1800*

Rs.1000 per month/ Rs. 12000 per annum (or) the actual fee paid whichever is lower*

CChildren of employees not covered under 1(a) &1(b) above

Same as above except the diploma courses for which item 2 below applies.

` 2400 per annum

‘C’03

Technical Scholarship Diploma courses (for employees not covered under 1(a) and 1(b) above.

Diploma in Engineering /Medicine/ Technology/ Architecture/ Environment /Planning

Rs. 1200/- per annum

*Note: The schemes have been announced by the Railway Board in the SBF Grants for the FY 2010-11, for which notification has been issued and expenditure is being incurred in FY 2011-12.

S.No Scheme

Eligibility Amount of grant eligible

Application to be

madeIn

Proforma

04

on-Technical Degree courses Non-Technical Education – Children of erstwhile Group ‘D’ Staff prosecuting Under Graduate Courses not covered under items above (B.A., B.Sc., B.Com.,etc.,)

Rs.1000/- per annum

‘D’

05Cash award for meritorious students

*see NOTE below

To all the children of Railway employees who come out in first to tenth ranks in the Common Entrance Examination and State Level Ranks in other courses in University level.

Rs. 5,000/- ‘E’

The following are the conditions governing the grant of scholarships under S.Nos. 2 to 4 above:

a) The applications should invariably be made in Proforma ‘B’, ‘C’ or ’D’ as the case may be.

b) The application should be made for the year of study the student is prosecuting during the academic year for which the notification has been issued.

c) The attested copy of mark list of the QUALIFYING EXAM should be enclosed to the application, for eg. The qualifying exam for Ist year Technical Degree courses would be INTERMEDIATE and for the subsequent years of study, the exam passed in the previous years and so on.

d) A ward should have successfully PASSED all the subjects in the qualifying exam to be considered for grant of scholarships.

e) The employees should mention their community viz. SC/ST/OBC/Minority/UR etc.,.

f) The Rate of Pay, Pay Band, Grade Pay, and PF number should also be mentioned in the application.

g) Application with INCOMPLETE details shall stand rejected.h) The scheme is open to all the Children/Dependents of a Railway employee

who prosecute any of the courses mentioned in para 5 supra. In other words, the grant of benefit under the scheme is not limited to one child at a time.

i) Applications should be made to the Chairman of the HQrs. / Divisional /Workshop SBF Committee under whose jurisdiction the employee is working, once the notification in this regard is issued by the HQrs.,/Division/Workshops.

NOTE: Applications for grant of Cash Awards for meritorious students should be made as and when the results are notified. Belated cases would not be considerecd.

(B) Grant to Railway Schools for Academic/Proficiency and Sports prizes:

With a view to inculcate a spirit of competition amongst the children of Railway employees studying in Railway Schools, the Chairman of Divisional SBF Committee shall sanction annual grants to each school on pro-rata basis of Rs.10/- per child to award proficiency prizes and sports prizes from the fund provided as per budget allotment for Colleges at the rate of 25/- per child is provided to award proficiency prizes and sports prizes.

B. RECREATION & AMUSEMENT

The SBF provides for the following towards recreation & amusement:

01 Children’s Camp Each Division/ Workshop/HQrs. shall conduct a camp once in a year, for children of Group’ C’ & ‘D’ employees who are aged between 12-15 years. The HQ SBF shall provide Rs. 1,00,000/- to each unit for conduct of the camp.

02 Employees Camp Each Division/ Workshop/HQrs shall conduct, once in a year a camp for its Group ’C’ &’D’ employees. The HQ SBF shall provide ` 1,50,000/- to each unit for conduct of the camp.

NOTE: The Camp for Differently Abled Employees would continue to be held on a Zonal Basis by the HQ Unit .

03. Grants from SBF to Cultural Activities:

For promotion of Fine Arts and Cultural Activities, the SBF Committee considers and entertains the request for grants to cultural programmes.

Applications for such grants should be submitted to the Divisional/Workshop S.B.F. Committee who will award grants judiciously for promoting cultural activities.

04. Handicraft Centres:Handicraft centres function at the following places on S.C. Railway.

Sl.No. Name of the Division Number of Centers

Located at

01 Secunderabad Division – 12

12 KZJ Diesel Colony, KZJ Station Colony, DKJ, VKB, BPA, Lalitha Nagar Colony, SC, R.K.Nagar,Colony, RDM, MFT, STPD, MLY, BDCR.

02 Hyderabad Division -09

09 Mahila Mandal/North Lallaguda, CKL, Rifle Range/SC, KCG, MBNR, KRNT, NZB, Bolarum, Mallikarjuna Nagar.

03 Vijayawada Division 09 Loco Shed Colony/BZA, UP Yard Colony/BZA, Traffic Colony/BZA, STPM, RJY, BVRM, BPP, OGL, Tuni.

Sl.No. Name of the Division Number of Centers

Located at

04 Naned Division 04 PAU, J, AK, AWB, NED

05 Guntur Division. 03 Sanjeevanagar Colony/GNT, NDL, DKD

06 LGD Workshop 01 Lallaguda

07 Guntupalli Workshops 01 Guntupalli08 CRS/TPTY 01 Tirupati

Total Centres 40

Each Handicraft centre is equipped with sewing machines and is manned by a qualified instructress.

The family members of the Railway employees who attend these centres are given training in the art of cutting, sewing, embroidery etc., in convenient batches. After they get sufficient training they are entrusted with the work of stitching garments received from the Stores Department, such as staff Uniform, school Children’s Uniforms, Hospital staff dresses, Banners Flags, Licensed Porter Uniforms, Pillow Covers, Mosquito Curtains are some of the items which are exclusively entrusted to the Handicraft Centres for Stitching. The stitching charges for these uniforms are distributed among the members of the centres according to the number of garment stitched by them. The family members of the Railwaymen have therefore, an opportunity in not only learning a useful trade during their spare time but also supplementing their family income by attending these centres.

The Staff Benefit Fund Committee sanctions sufficient funds for maintenance of the Handicraft Centres based on their membership. The rates w.e.f. 01.07.2006 are as under:-

(a) below 40 members ` 700/- p.m.(b) 40 members and above ` 1000/- p.m. per centre.

The honorarium to the Instructress shall be sanctioned by the Divisional/Workshop Staff Benefit Fund Committee under whose jurisdiction the HCCs’ function.

The Chairman of the Division/WS SBF Committees should submit half yearly reports on the working of these centres to the Chairman, Headquarters SBF Committee during the first week of April and October every year without fail.

C. RELIEF OF DISTRESS AND SICKNESS

The SBF provides for the following towards relief of distress and sickness:

S.No Scheme Eligibility

Amount of grant eligible

Application to be made in Proforma

01 Maintenance Grant

All Gr.”C” & “D” employees irrespective of their pay and nature of disease, subject to the sickness in Govt./Rly Hospital exceeding 15 days on LWP

Rs. 3000/- per month ‘F’

02 Medical Assistance

All Gr.”C” & “D” employees who themselves/their family members suffer from major diseases and chronic diseases involving major operations, on recommendation by Rly medical authorities.

Rs.1000/- per month for a maximum period of 3 months.

‘G’

03 Reimbursement towards cost of spectacles

All Gr.”C” & “D” employees who are required to wear spectacles for the better performance of their official duties.Periodicity (i) for employees below 45 yrs—once in 3 yrsii) for employees above 45 yrs-once in 2 yrs

Actual cost Rs.800/- or whichever is less.

‘H’

04

Financial assistance to children of Rly employees suffering from disabilities

A) Deaf, Dumb, Blind, Mentally challenged children of Rly employees attending special schools irrespective of the number of such children to cover tuition fee/transport.

Rs. 1000/- per month irrespective of the actual amount spent.

‘I’

B) Physically challenged children attending normal school-studying in Class I-X upto 3 such children for the expenditure incurred towards transport from residence to school and back.

Rs.500/- per month per child irrespective of the actual amount spent.

‘J’



Application to be made in Proforma

05Promotion of Girl child and adoption of Small family norms (effective from 22.10.2004)

For employees who themselves/their spouses adopt small family norms after begetting

i. One girl child 10,000/-‘M’

ii. One male child or two girl children 5,000/-

06

Assistance towards funeral expenses for the families of those Employees who died in Rly / Referral Hospitals while undergoing treatment * see NOTE ‘d’ below

a) Families of deceased employees who are locally situated (within 100 KMs). 5,000/-

‘L’b) Families of deceased employees who are situated at Out stations (beyond 100 KMs)

10,000/-

07Financial Assistance towards procurement of Artificial Limbs

All Group ‘C’ & ‘D’ employees suffering from disability of lower limbs of 50% and above.

Amount to be decided by the Chairman, HQ SBF Committee & CPO on a case by case basis.

NOTE: a. Applications in regard to benefits under schemes at S.Nos. 1 to 5 should be made to the Chairman of the HQ/Divn/Workshop SBF Committee under whose jurisdiction the employee works.

b. Applications for grants under schemes under S.No 7 should be made to the Chairman of the Divisional/Workshop SBF Committee who shall after a due scrutiny forward the ELIGIBLE CASES for obtaining the sanction of the Chairman, HQ SBF Committee & CPO.

c. The funds for grants to families of employees who die while undergoiung treatment at the Railway/Referral Hospital shall be placed at the disposal of the MD/CH/LGD, in regard to SC area and the CMS/BZA, GNT, GTL, NED, in regard to the Divisional Hospitals, who shall grant the amount to the family member of the deceased, after duly following the procedures.

d. Application for Maintenance Grant should be made within 03 Months from the date of resuming duty after the sickness. Maintenance Grant will be admissible for maximum period of 12 months. Individual cases requiring assistance for a longer period beyond 12 months should be referred to the Secretary, Headquarters SBF Committee, duly recommended by the medical authorities for consideration by the

Chairman, Headquarters SBF Committee & CPO on the merits of each case.

NOTE:Employees suffering from T.B. and undergoing treatment as in patients in Sanatoria should be granted maintenance grant by the Headquarters/Divisional/Workshop SBF Committee even beyond 12 months on application by the employee duly recommended by concerned DMO’s certifying the nature of sickness as T.B. and recommending the cases even for period beyond 12 months subject to availability of funds.

2. Grant to employees who sustain loss of property on account of Flood, Fire & Cyclones:

Under this scheme financial assistance shall be granted by the Committee to all non-gazetted Railway employees irrespective of their pay based on the merits of the case upto ` 500/- in the case of fire accidents and upto ` 100/- in the case of floods and cyclones less than the amount of the grant received by the applicants from the State Government on this account.

This scheme is controlled by the South Central Railway Headquarters SBF Committee, subject to the condition that applications are submitted by the distressed employees in the prescribed Proforma ‘K’ within one month from the date of occurrence.

D, INDIGENOUS SYSTEM OF MEDICINE

The SBF provides for the following under the head “Indigenous System of Medicine”:



1

Treatment in Naturopathy from a Hospital/Institute recognised by the State Government for Re-imbursement of medical expenses

All Group ‘C’ & ‘D’ and their family members who are covered under Railway Servants (Pass) Rules(Once in a Life Time Affair)

50% of the cost incurred subject to a maximum of Rs. 5000/-

‘N’

The salient points of the scheme are be as under:

• The Scheme would be controlled by the Headquarters Staff Benefit Fund Committee.

• The treatment would be available to the Railway employees and their family members covered under Railway Servants (Pass) Rules.

• The treatment would be “Once in a Life Time affair”

• The treatment can be had in any Hospital/Institute, recognized for Reimbursement by the State Government, which gives treatment in Naturopathy.

• A re-imbursement to the extent of 50% of the cost incurred, subject to a maximum of ` 5000/-(Rupees Five Thousands only) shall be available

• Applications for re-imbursement may be made to the Chairman, Divisional/Workshop SBF Committee & the Sr. DPO/WPO after availing the treatment, who shall after due scrutiny forward the eligible cases for obtaining the sanction of the Chairman/Vice-Chairman, HQ SBF Committee. The ORIGINAL BILL should invariably accompany the application.

02 Homeo clinics. Available at the following hospitals: CH/LGD; RH/KZJ; RH/GTL; RH/GY; RH/BZA.

03 Ayurvedic clinic Available at CH/LGD.

In regard to the functioning of the Clinics under S.Nos.02 & 03 above, the SBF provides for payment of Honorarium to the Physician and the Helper as also re-imburses the cost incurred towards medicine. The Honorarium payable to the Physician of Homeo as well as the Ayuredic clinics / Helper of the Ayurvedic Clinic are fixed by the Railway Board from time to time while the aspect of cost towards medicines and the Honorarium payable to the Helper of the Homeopathic Clinics are decided by the HQ SBF Committee. (04) Homeo Clinics

On the recommendations of DRMs Headquarters SBF Committee provides grant for opening Homemo Dispensaries where there is a large concentration of Railway employees.

A grant of ` 1500/- (Rupees one thousand five hundred only) per annum for purchase of medicines and ` 800/- (Rupees eight hundred only) per month towards honorarium for the doctor of each dispensary is provided.

GENERAL: The Headquarters SBF Committee shall have the RIGHT to consider Financial Assistance to cases of employees not covered under any of the above schemes. They shall also have the power to alter/modify/include/delete any aspect of the existing schemes as also introduce any new scheme at any time, without assigning any reasons therefor. The decision of the HQ SBF Committee shall be FINAL and BINDING and no correspondence in this regard would be entertained.

For further details and application forms, the Welfare Section of HQrs., Divisions and Workshops may be contacted. Their Railway phone numbers are given below;

Sl. No.Division/ Workshops Phone No.

Railway1 Headquarters Office 86603

2 Secunderabad Division 86649

3 Hyderabad Division 85207

4 Vijayawada Division 68293

5 Guntakal Division 27078

6 Guntur Division 32625

7 Nanded Division 52266

8 Carriage Workshops, Lallaguda

89413

9 Wagon Workshops, Guntupalli

63636

10 Carriage Repair Shop,Tirupathi

25452, 25454

11 S & T Workshops, Mettuguda

89262, 84114

Chairman, Headquarters SBF Committee & Chief Personnel Officer

PROFORMA – ‘A'

Application for an Advance for Correspondence Course offered by B.I.E.T.Mumbai/ICWA Kolkata/Institute of Rail Transport and

Management/NDLS / Technical Education & Material Management in the evening colleges from the SBF

PHONE NUMBER The Secretary, Railway : South Central Railway, Mobile : HQrs. / Divisional / Workshop SBF Committee,Sir,

I hereby apply for an advanced from Staff Benefit Fund to pay the fees in lump sum for the correspondence course in ……………..offered by the BIET, Mumbai/ICWA, Kolkata, Institute of Rail Transport and Management, NDLS / Technical Education / Material Management in the EVENING COLLEGE. (Strike out which ever is not applicable)

1 Name of the employee in full (in Block letters)

1(a) Son of / Wife of (In case of female employee)

2 Date of Appointment Bill Unit Number

3 Community(Tick Mark)

SC ST OBC Muslim Christian UR

4 Designation Office/Station5 Department/Division P. F. Number6 Pay in Pay Band Running

Allowance7 Grade Pay Substantive Grade Pay

Officiating / MACP

8 Particulars of course and amount of ees.a) course studyingd)Duration of coursed) Amount of fees paid during the year

9 Whether certificate from the B.I.E.T.Mumbai, KCWA, Kolkata, IRTM/NDLS/ College of study is enclosed.

10 Amount of advance applied for

I authorize the Administration to recover the amount from my salary in 10 equal monthly instalments.Place………..Date………… Signature of the Applicant.Memo No………………….. Office:………..

Date:……..Forwarded for necessary action. The above particulars furnished by the employee are correct.

Controlling Officer.(Designation)(Office Stamp)

PROFORMA – ‘B'Application for Special Scholarship for Technical Education

(Scheme is open only to such of those employees who SUBSTANTIVELY hold the Grade Pay 1800 & below)

To TELEPHONE NUMBER The Secretary, Railway : South Central Railway, Mobile : HQrs. / Divisional / Workshop SBF Committee,








Officiating / MACP

8 Name of the student in whose favour the scholarship is sought for

Relationship with the employee

9 Course Studying

10 Year of Study in 2010-11, viz., 1st Yr, 2nd Yr, 3rd yr, 4th Yr etc., in 2010-11

11 Name of the Institution where studying

12 Whether the child is in receipt of any other scholarship and it so, the value.

`

13 Whether the child is exempted from payment of term/tuition fee and if so, the value.

`

14 Whether the student is employed and is having his/her own resources.

15 In case, where the student is a dependent of the employee:-

I hereby declare that all the particulars furnished above are true and I am liable for disciplinary action, if they are proved to be incorrect at a later date.

I also declare that the student Master/Kumari………………. Is related to me as ………………… My father is not alive and the student is entirely dependent on me and the particulars as furnished by me are correct.

Date:Place: Signature of the employee

- 2 -

Witnesses:

We hereby declare that the parciulars furnished by

Shri./Smt. __________________________ Designation _____________ are

correct to the best of my knowledge:

S.No. Name (in BLOCK LETTERS)

Designation/Office/Station

Signature

01

02

Memo No. Office

Date Station:

Forwarded, It is certified that the particulars furnished against item 1 to 7 & 11 have been verified and found correct.

Signature & Designation of the Pass Issuing Officer.

Documents to be enclosed to the application:

1. Community Certificate, in case of SC/ST/OBC employees.

2. Attested copy of the Mark Lists of the Qualifying Examination, viz., the exam passed in the Academic Year 2009-10.

3. Certificate from the College of study on Fee Payment.

Please note that no coloumn should be left blank. The telephone

number should be furnished

Name of the college with seal.Affiliated to :

CERTIFICATE

This is to certify that Kum./Master_____________________

Son/Daughter of Shri_____________________, is/was a student of

this college studying in _________________( course)____________

(Year of study –1st Yr, 2nd Yr, 3rd Yr, 4th Yr etc.,) during the Academic

year 2010-11.

2. The student has remitted an amount of Rs ____________

(Rupees ____________________________________________________ only)

towards college fee during the Academic Year 2010-11. It is also

certified that the student is NOT EXEMPT from payment of FEE and is

also not in receipt of any SCHOLARSHIP from any other sources.

3. This certificate is issued to the student to enable her to obtain

SCHOLARSHIP from the Staff Benefit Fund of the Railways.

PLACE:

DATE: Signature of the Authorized Signatory with

College Seal

_____________________________________________________________________Details of the Bank Account held by the Scholar Child

1. Name of the Account Holder :2. Account Number :3. Bank and Branch :4. IFSC Number :5. MICR Number :

Signature of the Authorised Signatory with seal

PROFORMA – ‘C'

Application for Scholarship for Technical Education









Officiating / MACP



9 Course Studying

10 Year of Study in 2010-11, viz., 1st Yr, 2nd Yr, 3rd yr, 4th Yr etc., in 2010-11

11 Name of the Institution where studying12 Whether the child is in receipt of any

other scholarship and it so, the value.Rs.


Rs.





Date:Signature of the employee

- 2 -

Witnesses:






Signature

01

02

Memo No. Office

Date Station:







Please note that no coloumn should be left blank. The telephone number should be furnished


CERTIFICATE





year 2010-11.

2. The student has remitted an amount of ` ____________

(Rupees ____________________________________________________ only)






PLACE:


College Seal

PROFORMA’D’Application for adhoc grant from SBF for Non-Technical Degree

courses (Available to employees in GP 1800 & below)







4 Designation Office/Station

5 Department/Division P. F. Number

6 Pay in Pay Band Running Allowance

7 Grade Pay Substantive Grade Pay Officiating / MACP



9 Course Studying10 Year of Study in 2010-11, viz., 1st Yr,

2nd Yr, 3rd yr, 4th Yr etc., in 2010-1111 Name of the Institution where studying12 Whether the child is in receipt of any

other scholarship and it so, the value.Rs.


Rs.





Date:Signature of the employee

- 2 -

Witnesses:






Signature

01

02

Memo No. Office

Date Station:







Please note that no coloumn should be left blank. The telephone number should be furnished


CERTIFICATE





year 2010-11.

2. The student has remitted an amount of ` ____________

(Rupees ____________________________________________________ only)






PLACE:


College Seal

PROFORMA – ‘E’

GRANT OF CASH AWARDS FOR MERITORIOUS WARDS OF RAILWAY EMPLOYEES FOR ACHIEVING ACADEMIC EXCELLENCE











8 Name of the student in whose favour the Cash Award is sought for


9 Course Completed

10 Year of Completion

11 Name of the Institution where studied

12 Nature of Academic Excellence achieved

I hereby declare that all the particulars furnished above are true and correct and I have enclosed copies of relevant certificates issued by the University in this regard. I also understand that the submission of the application does not automatically entitle my son for the award.

Date:Place: Signature of the employee

Forwarded to the Chairman, HQ SBF Committee & CPO for a consideration.Signature of the Controlling Officer with Stamp

PROFORMA ‘F’Application for Maintenance Grant


Sir,I have been sick from……………………..and without pay from …………

Please therefore sanction maintenance grant in my favour. Particulars required are furnished below.

Period of sickness as in patient………………..

Period of sickness as out patient ………………

Date: ………………. Yours faithfully,

Signature of the Applicant(to be filled in by the office where the applicant i.e. working)









7 Grade Pay Substantive

Grade Pay Officiating / MACP

8 Period of Sickness From ToA With PayB With Half PayC Without Pay9 Sick Certificate Number & Date10 Sick Certificate issued by

(Designation of the Railway / Govt. Medical Officer

Forwarded to DMO/………….. It is certified that the particulars given above are correct. He has already been paid maintenance grant for the period from ……….. to ………vide sanction letter No. …….. dated …………….

Office/station Controlling Officer

Designation Stamp to be affixed

Memo No. Date Office/Stn

Recommended. The employee is on Sick List from _____________ to _______________ vide M 8 B Certificate No. ______________ Dated _________

Period of Sickness as in patient: From: To:

Period of Sickness as out patient: From: To:

Nature of illness:(Common name as can be understood by Non-Medical Staff Should be given)

Divisional Medical Officer(Signature with Stamp)

ANNEXURE – ‘G’Application for Grant of Medical Assistance for Major Diseases and

Chronic Cases involving Major Operation.







4 Designation Office/Station5 Department/Division P. F. Number



8. For whom the assistance is applied for

9. Name of the dependent & Relationship, If the assistance is for dependent

Date: Signature of the employee.Memo No. OfficeDate: Station:Forwarded, it is certified that the particulars given above are correct.

Controlling Officer.(Designation Stamp)

Memo No. Date: Office:______________Station:___________

Recommended. Certified that the employee/dependent family member named has undergone major operation for on and is suffering from which is major disease/chronic case. She / He is/was under treatment from . to

(Strike off whichever is not applicable) Divisional Medical Officer,

(Designation Stamp to be affixed)

PRFORMA ’H’Application for Reimbursement of the Cost of Spectacles

TELEPHONE NUMBER The Secretary, Railway : South Central Railway, Mobile : HQrs. / Divisional / Workshop SBF Committee,I hereby apply for the reimbursement of the cost of spectacles purchased by me.1 Name of the employee in full (in

Block letters)(a) DATE OF BIRTH(b) S/o / W/o (In case of female employee)








13. Whether applied previously, if so, when & what is the result

14. Receipt Number & Date(ORIGINAL RECEIPT to be enclosed)

15 Cost incurred in the purchase

I declare that I have not claimed reimbursement of cost of spectacles during the last 02 / 03 Financial Years. The particulars furnished by me above are true and I am liable for disciplinary action if proved untrue.Encl: Yours faithfully

Date:Station: Signature of the ApplicantMemo Office:

Date:Forwarded to DMO/………………. It is certified that the particulars given against 1 to 12 are correct.

Controlling Officer. (with Office Stamp)

Memo No.OfficeDate:

ForwardedThe spectacles/change of spectacles are necessary for proper vision.

This employee is required to keep a pair of spectacles on duty(Strike off whichever is not applicable)

Divisional Medical Officer. (Designation Stamp)

PROFORMA ’I’Application for grant of financial assistance from SBF for the

children of Railway employees attending Schools for Deaf, Dumb, Blind and

Mentally retarded.









Officiating / MACP

8 Name of the Deaf, Dumb, Blind or mentally retarded child

9. Relationship10 Date of Birth & Aged of child11 Name of the School for Deaf, Dumb, Blind or

Mentally retarded and place where the student is studying and residing in without fail.

12 a)Amount of tuition fees paid per monthd) Amount of Transport charges paid per month.c) Amount of residential fees paid per month.

13 Grant of SBF received upto14. Amount now claimed:A Period of claim (From – To)B Tuition feesC Residential feesD Conveyance charges incurred15. Whether Vouchers/stamped receipts

enclosed.16. Whether the students is in receipt of any

financial aid from any other source for this purpose, if so, full particulars

The particulars mentioned above are true and the amounts received in this respect will be refunded, if the same are found incorrect. I also declare that the child for whom the FA is sought from SBF is not in receipt of the Children Education Allowance (Re-imbursement of Tuition Fee).

Date Signature of the applicant

Certified that the particulars furnished against columns 6 to 11 are correct and that the child (name)…………………………………………………..is a bonafide student of this Institution studying in …………………class. The duration of his/her course of studies extends upto _______________. He/She is not in receipt of any scholarship/Stipend/bursary from any other source. His/her conduct and progress is satisfactory.

The tuition fees/residential fees referred to above are recommended as these are essential for the prosecution of studies in the Institution.

Seal of the Institution Signature of the Principal

Place:____________ Name of the Institution

Date: ___________

Memo No. Date: Office of the

Forwarded to DMO _____________________

The particulars furnished against columns 1 to 5 are correct.

Signature of the Controlling OfficerDesignation

Memo No. Office:_________________Station: _________________Division: _______________

Forwarded to the Secretary, Headquarters SBF Committee, CPO’s Office, SC for necessary action.

The above particulars furnished by the employee are correct and the case is recommended for sanction.

Divisional Medical Officer.

PROFORMA ‘J’

Application for sanction of financial assistance in favour of Physically Handicapped and School going Children of Railway

Employees.


I hereby apply for financial assistance for my Physically Challenged School going son/daughter to cover the cost of transport from residence to school & back. Necessary particulars are furnished below: 1 Name of the employee in full (in

Block letters) 1(a) Son of / Wife of (In case of female

employee)2 Date of Appointment Bill Unit

Number3 Community

(Tick Mark) SC ST OBC Muslim Christian UR





8 Name of the Physically Challenged student ward in whose favour the scholarship is sought for


9 Date of Birth of the School going Child

Class studying

10 Name of the School in which studying at present.

11 Nature of physical disability

12 Financial assistance from SBF received upto13 Period for which Financial assistance is now

claimed (From – To)

The particulars furnished above are true and the amount received in this respect will be regunded if the same are found incorrect.

Date: Signature of the applicant.

PROFORMA ’J’

No. Date:

Certified that the particulars furnished against columns 8 TO 11 are correct and the child Master/Kumari. Is/was bonafide student of this institution studied last year in Class and at present studying in class academic year 20 . It is also certified that the student is a physically handicapped person.

Signature of the HeadmasterName of the Institution (Stamp)

Memo No. Date Office

Forwarded to DMO ………………………………………… The particulars furnished against columns 1 to 8 are correct.

Office seal:Signature of the Controlling Officer.

With Designation Stamp. Memo No. Date Office

Forwarded to the Secretary, HQrs. SBF Committee, CPO’s Office/SC for necessary action.

It is certified that ……………………………son/daughter of Shri ………………….. is a physically handicapped person.

The nature disability………………………….

Divisional Medical Officer with stamp

PROFORMA ‘K’Application for Grant of financial assistance for loss of property on

Accountof Fire, Flood and Cyclone











8 Nature of loss sustained9 Date of occurrence10 Financial loss sustained in detail11 Certificate from the Police or Civil authorities12 Whether any financial assistance is received

from State Govt. & if so the amount received.DA: CertificateDate:

Signature of the employee.Memo No. Office:___________

Station:___________Date: ____________

Forwarded, it is certified that the particulars given above are correct and correct and I recommend/do not recommend this case for financial assistance for sanction..

Controlling Officer.(Designation Stamp to be affixed)

ANNEXURE- L

Application for grant of Financial Assistance to the families of employees who die while undergoing treatment at RAILWAY/

REFERRAL Hospitals.***

My husband/wife/father/mother, who is a serving Railway employee has died while under treatment at Central Hospital, Lallaguda / Referral Hospital, RH/BZA; GTL; GNT; NED; Poly clinic/ KZJ; . His/ Her details are as under:

Name of the deceased

employee (in Block letter)

Designation & Station

Division/ Unit

P.F Number

Date of Death

Address where the last rites

are to be performed

I request that Financial Assistance, as due and admissible may be paid to me from HQ SBF.

Signature/LTI of the Applicant

Name :(in BLOCK LETTER)Relationship withThe deceased :

No. Office:

The family of the deceased employee is entitled for a FA of Rs 10,000/ Rs. 5,000 from HQ SBF. The same may please be sanctioned.

OS/Railway HospitalsSr. MS/Admn./In charge Physician

Received an amount of ` 10,000/ ` 5,000 from MD/CH/LGD/CWS (BZA; GTL;GNT;NED) Sr. MS/KZJ.

The payment has been made in on Signature of the receiverPresence:

Sl. No

Signature Name & Designation

1

2

PROFORMA ‘M’

APPLICATION FOR GRANT OF CASH INCENTIVE FOR ADOPTING SMALL FAMILY NORMS AFTER ONE GIRL CHILD OR ONE MALE/TWO FEMALE

CHILDREN.To TELEPHONE NUMBER The Secretary, Railway : South Central Railway, Mobile : HQrs. / Divisional / Workshop SBF Committee,

I hereby apply for grant of cash incentive for adopting small family norms after one girl child or one male/two female children. Necessary particulars are furnished below: 1 Name of the employee in full (in


employee)1(b) Date of Birth

2 Date of Appointment Bill Unit

Number3 Community

(Tick Mark) SC ST OBC Muslim Christian UR






8 Family compositionS.No.

Name of the dependent

Relationship

Age/DOB Remarks

9 Number of living children (on the date operation)

MALE FEMALE TOTAL

10 Sterilization operation particulars.

Date of operation

Hospital/Clinic where the sterilization operation was

performed

(Note: In case the operation was done in a private Hospital, the certificate should be got countersigned by the Railway Doctor. In other cases, the copy of the certificate should attested by a Railway Officer).

Signature of the employee

DECLARATION

I hereby declare that the particulars furnished above are true complete and correct to the best of my knowledge and belief and that no fact has been concealed to derive the incentive from SBF. I also declare that the above incentive has not been claimed by my spouse (in case the spouse of the employee is also a Railway employee) / my spouse is not employed on Railways.

I fully understand that should the information provided by me is found to be incorrect at a later date, the amount granted to me is fully recoverable from my salary and I shall not take legal recourse to avoid such recovery. I am also aware that I am liable to be taken up under D&A Rules in case the information provided by me is found to be false/incorrect.

Place:Date: Signature of the employeeWe, the co-employees of Shri…………………………………………………………………Design……………………Station…………………. Hereby certify that the information furnished by Shri …………………………. Is true complete and correct to the best of our knowledge. We also certify that the declaration has been signed by Shri …………….. in our present.

S.No. Name Designation Office/Stn. Signature

No. Office

Station

Date:

Forwarded to Chairman/HQrs. SBF Committee & CPO/SC for necessary action. The particulars furnished by the employee have been verified with the Service Register / Pass Declaration of the employee and found to be IN ORDER.

SignatureDesign. & Stn.(with office seal)

PROFORMA ‘N’APPLICATION FOR RE-IMBURSEMENT OF 50% EXPENSES INCURRED

ON TREATMENT IN NATUROPATHY To TELEPHONE NUMBER The Secretary, Railway : South Central Railway, Mobile : HQrs. / Divisional / Workshop SBF Committee,

I hereby apply for re-imbursement of 50% expenses incurred on treatment in naturopathy, in favour of myself/my family member covered under RS(Pass)Rules. . Necessary particulars are furnished below: 1 Name of the employee in full (in


employee)1(b) Date of Birth









8 Details of the family member who underwent the treatment in Naturopathy

S.No.

Name Relationship

Age/DOB Remarks

9 Name & Address of the Hospital/Institution where the treatment was taken

10 Whether the Hospital/Institute is recognized by the Government, if so the details of the Govt. G.O (a copy of the G.O. should be enclosed in support.

11 Amount incurred towards treatment(ORIGINAL BILLS in support should be enclosed)

Signature of the employeeDECLARATION

I hereby declare that the particulars furnished above are true complete and correct to the best of my knowledge and belief and that no fact has been concealed to derive the incentive from SBF. I also declare that I have not claimed the above grant in my favour/in favour of the family member for whom this is claimed. I also declare that the family member for whom the claim has been made is fully dependant on me and is also included in my PASS DECLARATION. I am fully aware that I would not be eligible to claim the grant in favour of myself/my dependant inb whose facvour the claim is made.

I fully understand that should the information provided by me is found to be incorrect at a later date, the amount granted to me is fully recoverable from my salary and I shall not take legal recourse to avoid such recovery. I am also aware that I am liable to be taken up under D&A Rules in case the information provided by me is found to be false/incorrect.

Place:Date: Signature of the employeeWe, the co-employees of Shri…………………………………………………………………Design……………………Station…………………. Hereby certify that the information furnished by Shri …………………………. Is true complete and correct to the best of our knowledge. We also certify that the declaration has been signed by Shri …………….. in our present.

S.No. Name Designation Office/Stn. Signature

No. Office

Station

Date:

Forwarded to Chairman/HQrs. SBF Committee & CPO/SC for necessary action. The particulars furnished by the employee have been verified with the Service Register / Pass Declaration of the employee and found to be IN ORDER.

SignatureDesign. & Stn.

(with office seal)