BENEVOLENT FUND AND GROUP INSURANCE
INTRODUCTION: 12.1Benevolent Fund and Group Insurance are
regulated by the Federal Employees Benevolent Fund and Group
Insurance Act, 1969, as amended vide Act .No.XXV of 1975, Ordinance
XLIX of 1980 and Ordinance No.VI of 1988.Broadly speaking, the Act
applies to all civil servants including-(i)person appointed to the
Secretarial staff of the National Assembly or the Senate, or any
officer or servant of the Supreme Court or of the Election
Commission, or(ii)any officer or servant of such body Corporate
Institutions, Organizations or Autonomous Bodies as the Federal
Government may, by notification in the official Gazette, specify,
and(iii)any such person, officer or servant, as aforesaid, who is
on deputation elsewhere or on foreign service within the meaning of
the Fundamental Rules, or(iv)undergoing study or training in or
outside Pakistan, or(v) on leave(vi)under suspension;but does not
include any person who-(a)is an employee of the Railways?(b)has
attained the age of 60 years; or(c)is an officer or servant of a
Provincial Government on deputation to Federal
Government?DEFINITIONS:12.2The family for the purpose means-(a)In
the case of male employee, the wife or wives and in the case of a
female employee, the husband of the employee, and(b)The legitimate
children, parents, minor brothers, unmarried, divorced or widowed
sisters of the employee wholly dependent upon him.12.3The term
'Pay' includes emoluments, which reckon for pension and the pay an
employee would have drawn but for his deputation, suspension or
leave.
BENEVOLENT FUND:12.4Every employee is required to pay to the
Benevolent Fund a monthly subscription equal to one percent of his
pay maximum Rs.26. whichever be less.The amount of subscription, as
far as possible, should be deducted at source from his pay and
credited or remitted to the Benevolent Fund.12.5If the amount of
subscription, for any reason, cannot be deducted from the pay of
the employee, he should remit it to the officer prescribed for the
purpose. Any amount of subscription remaining unpaid due to
inadvertence or negligence of the employee or otherwise should be
recovered from him in such manner as may be prescribed by the
rules.12.6Default in the payment of subscription either from the
reason that the pay of the employee was not drawn or due to his
inadvertence, negligence or fault or any other reason whatsoever
would not affect his right or the right of his family to receive
the benevolent grant, but the amount of unpaid subscription may be
deducted therefrom. 12.7Benevolent grants are paid from the
Benevolent Fund,if an employee(a)is declared by the prescribed
medical authority to have been completely incapacitated physically
or mentally to discharge the duties of his employment and is for
that reason removed from service, or(b)dies during the continuance
of his employment or, if he has retired from service within the
prescribed period before attaining the age of sixty five years, he
or in the event of his death, his family will be entitled to
receive a benevolent grant from the Benevolent Fund according to
the scale mentioned below, for a period of ten years or upto the
date on which the employee attains or might have, if he were alive,
attained the age of sixty five years, whichever is earlier. In the
case of an employee, who dies after having drawn the benevolent
grant, the period of ten years will be reckoned from the date from
which he began drawing such grant. In case of retired employees the
amount of grant will be determined on the basis of the pay last
drawn:PayRangeRate of monthly Benevolent Grant.
In the case of employee whose pay last drawn was between:-
250 and 300150
301 and 400175
401 and 500200
501 and 600225
601 and 700250
701 and 800275
801 and 900300
901 and 1000325
1001 and 1100350
1101 and 1200375
1201 and 1300400
1301 and 1400425
1401 and 1500450
1501 and 1600475
1601 and 1700500
1701 and 1800525
1801 and 1900550
1901 and 2000575
2001 and 2100600
2101 and 2200625
2201 and 2300650
2301 and 2400675
2401 and 2500700
2501 and 2600725
2601 and above.750
[Finance Division Notification No.F.17(1)/80-Pub dated
29thSept., 1980]12.8On the death of an employee the amount of
benevolent grant payable under will be paid to such member or
members of his family as he might have nominated in full or in the
shares specified by him at the time of death of an employee.The
amount of benevolent grant will be paid to such member or members
of his family, subject to such conditions imposed with a view to
ensuring that the amount is justly and equitably utilized for the
maintenance and benefit of all the members of the family, as may
bedetermined by the Board of Trustees of the Federal Employees
Benevolent and Insurance Fund.GROUP INSURANCE:-12.9In the event of
the death of an employee, occurred by whatever cause, during the
continuance of his employment, the family of the deceased employee
will be paid the sum assured as under:*In the case of an employee
whosepay last drawn was at the monthlyrate of:Sum assured.
two hundred and fifty rupeesor more but not more than five
hundred nipeeesseven thousand and fivehundred rupees.
More than five hundred rupeesbut not more than seven hundredand
fifty rupees.fifteen thousand rupees.
more than seven hundred andfifty rupees but not more than
onethousand rupees.twenty-two thousand and fivehundred rupees.
more than one thousand rupees but not more than one thousand and
five hundred rupees.thirty thousand rupees.
more than one thousand and fivehundred rupees.forty-five
thousand rupees.
*Substituted vide Ordinance No.XIII of 1981 No.F. 17(1)/1-Pub
dated 2-5-1981 Published in the Gazette of Pakistan Extraordinary.
Part-112.10The provisions contained in paragraphs 12.5,12.6 and
12.8 willbe equally applicable in the case of payment of the sum
assured.12.11The employees in B-l6 and above have to pay the life
insurancepremium at the following rates which are to be deducted at
source from theirpay and credited and remitted to the Insurance
Fund:Pay rangeSum assuredRate of monthly premium
UptoRs. 5007,5002.62
Rs. 501 to 75015,0005.24
Rs. 751 to 100022,5007.86
Rs. 1001 to 150030,00010.50
Over Rs. 150045,00015.75
12.12The following procedure is to be observed for the
collection ofpremium and subscription for the Insurance Fund and
Federal EmployeesBenevolent Fund respectively.(i)In the case of
B-16 & above officers the deductions are to be madeby officers
themselves from their paybills/computerised payroll.(ii)For the
establishment the Drawing and Disbursing Officers haveto make the
deduction from establishment paybills/computerisedpayrolls in
respect of Benevolent Fund only.(iii)No deduction on account of
Group Insurance premia is to bemade in respect of B-l to B-l 5
establishment, as it is to be paid bythe Government. However, the
amount to be paid by the Government on that account should be
worked out at theprescribed rate and shown in the relevant columns
of schedule inFormTR-55-A.(Finance Division letter No F. 6-11/69-B
III dated 12thApril 1969)PAYMENT OF SUBSCRIPTIONS OR PREMIA IN
DEFAULT:12.13Where the amount of subscription to the Benevolent
Fund or the premium to the Insurance Fund cannot, for any reason,
be deducted from the pay of an employee, the employee shall(a)in
case he is serving abroad, remit the amount to the head of his
department; and(b)in any other case, remit the amount to the
Secretary.12.14In the case referred to in clause (a) the head of
department and in the case referred to in clause (b) the Secretary
shall deposit the amount received by him to the credit of
Benevolent Fund or, as the case may be, the Insurance Fund, in the
National Bank of Pakistan or any other scheduled bank approved by
the Board.12.15Any amount of subscription to the Benevolent Fund or
any premium to the Insurance Fund remaining unpaid due to
inadvertence or negligence of the employee or otherwise shall upon
a direction in writing of the Board, be deducted, in the case of an
employee of an Organization, by the head of the Organization, and
in any other case, by the Accounts Officer, from the salary of such
employee.12.16Where the Accounts Officer or the head of the
Organization as the case may be, upon a request being made in
writing by the employee finds that deduction of the amounts
remaining unpaid will result in any hardship to the employee, he
may deduct the amount in such number of instalments, not exceed ing
twelve, as he may decide.MEDICAL AUTHORITY FOR DECLARING AN
EMPLOYEE INCAPACITATED:12.17The medical authority which, in
accordance with the rules or regulations governing his employment,
declares an employee to have been completed incapacitated
physically or mentally to discharge the duties of his employment
shall be the medical authority for the purposes.Nomination of
beneficiaries of the benevolent fund grant and of the
assured:12.18(i)Every employee shall make a nomination conferring
on one or more members of his family the right to receive a
specified share of the benevolent grant or the sum assured that may
be payable.(ii)The employee may provide in the nomination(a)that,
in the event of any one of the nominees predeceasing the employee,
the right conferred upon that nominee under (i) shall pass to such
other member or members of the employee's family as he may specify
in the nomination; and(b)that the nomination in respect of all or
any of the nominees shall become void in the event of the happening
of any con tingency specified.(iii)Every nomination shall be in
Form 'A'.(iv)An employee may at any time cancel a nomination made
under (i)and make a fresh nomination.(v)A nomination under (i), or
a fresh nomination under (iv), made by an employee shall be in
triplicate and one copy of the nomination or, as the case may be,
fresh nomination shall be signed by the head of the office and
returned to the employee, one copy shall be placed in the
Confidential Report, or, as the case may be. Service Book of the
employee and the third copy shall be placed in the Master Folder to
be maintained by the department concerned.(vi)A nomination under
(i), or a fresh nomination under (iv), made by an employee shall,
to the extent it is valid, take effect on the date on which it is
received by the department to whom it is sent under (v).PAYMENT OF
BENEVOLENT GRANT AND THE SUM ASSURED WHERE NO VALID NOMINATION
EXISTS:12.19Where no valid nomination made by the employee subsists
at the time of his death in relation to the whole of the amount of
the benevolent grant and the sum assured or any part thereof, the
whole amount or, as the case may be, the part to which the
nomination does not relate, shall be paid to the member or members
of the family of the deceased employee in the manner hereinafter
appearing:-(a)The Board or an officer authorised by it in this
behalf, may determine the members of the family of the deceased
employee who are eligible to receive the benevolent grant and the
sum assured:Provided that if the members of the family of the
deceased employee are determined by an officer authorised by the
Board, any member may, within thirty days of such determination,
appeal to the Board.(b)If the members of the family of the deceased
employee agree to nominate any one of them to receive the
benevolent grant and the sum assured, the payment shall be made to
that member.(c)If there is no such agreement, the payment shall be
made in the following manner:-(i)if the deceased employee is
survived by wife or, as the case may be, husband, the benevolent
grant and the sum assured shall be paid to her or, as the case may
be, him; and, in case the deceased employee is survived by more
than one wife, the amount of the benevolent grant and the sum
assured shall be distributed between them in the ratio of the
number of members each one of them will maintain:Provided that the
recipient shall undertake to utilize the amount so received for the
maintenance and benefit of all the members of the family of the
deceased employee;(ii)if the deceased employee is not survived by
wife or, as the case may be, husband, the amount of the benevolent
grant and the sum assured shall be distributed amongst the members
of the family of the deceased employee keeping in view the
require-ment of each member.SUBMISSION OF APPLICATION FOR
BENEVOLENT GRANT AND GROUP INSURANCE:12.20(i)On the death of an
employee during the continuance of his employment, the head of the
office of such employee shall forward through the head of the
department, anapplication in Form 'B" to the Board for payment of
the benevolent grant and the sum assured.(ii)When an employee is
declared by the medical authority to have been completely
incapacitated physically or mentally to discharge the duties of his
employment and is for that reason, removed from service, the head
of the office of such employee shall forward, through the head of
the department, an application in Form "B" to the Board for payment
of the benevolent grant.(iii)Upon receipt of an information that a
retired employee has died within the period laid down, the head of
the office where from such employee retired shall forward, through
the head of the department, an application in Form 'B' to the Board
for payment of the benevolent grant.(iv)Upon receipt of an
application, the Board shall, after making such enquiry and taking
such evidence in the case of an application as it may consider
necessary, pay the benevolent grant, or the sum assured, or both as
the case may be. to the person entitled to receive it.FORM'A'Name
and Designation of the employee..
Service/Department..........................................................I
hereby nominate the person/persons mentioned below who is/are
member/members of my family as defined in Section 2 of the Federal
Employees Benevolent Fund and Group Insurance Act, 1969 (II of
1969), to receive the benevolent grant and the sum assured in the
event of my death.PART-1(For wife/husband
only)----------------------------------------------------------------------------------------------------------------Name
of nominee/nominees Relationship Age Specification of share
Remarks----------------------------------------------------------------------------------------------------------------
(For members of family other than
wife/husband)----------------------------------------------------------------------------------------------------------------Name
of nominee/nominees Relationship Age Specification of share
RemarksCertified that the member or members of my family mentioned
in Part-II reside with me and are wholly dependent upon meThe
earlier nomination made by me may kindly be treated as cancelled.
(---------------------------------)Dated---------------------
Signature or thumb impression of the employeeWitness:
(Name in block letters)------------------------------ Service
and Department1. (Signature/thumb
impression)----------------------------------------- (Name and
Designation in block letters)-------------------------------2.
(Signature/Thumb
impression)-------------------------------------------(Name and
Designation in block
letters)------------------------------------------------- Signature
and seal of the head of the office
FORM'BAPPLICATION FORM1. Name of the deceased/incapacitated
employee. ----------------------------------------------2. His/her
Service or Department.
---------------------------------------------3. Head of the Service
or Department. ----------------------------------------------4.
Last appointment held
----------------------------------------------5. (a) Pay per
mensum. (i)Basic pay ----------------------------------------------
(ii)Special pay ----------------------------------------------
(iii)Technical pay ----------------------------------------------
(iv) Personal pay ----------------------------------------------
(v)Indexation pay ----------------------------------------------
(b) Certificate of the Head of the Department regarding pay:
Attached with Annexure.
----------------------------------------------6. Date of Birth (as
verified from Service Book).
----------------------------------------------7. (a) Date of death
(three copies of the certificatefrom the Head of Department or
Medical Officeror extract from the Register of birth/death of
UnionCouncil/Union Committee/Muncipal Committee.
--------------------------------------------- (b) Date of removal
from service on account of incapacitation
---------------------------------------------8. (a) Name/Names of
nominee/nominees. --------------------------------------------- (b)
Copy of nomination Form. Attached vide Annexure
-----------------------------------9. Name of other family members
of the deceased (in case no valid nomination subsists).
---------------------------------------------10. Address of the
nominee/incapacitated employee where correspondence can be made.
---------------------------------------------11. Branch of the
National Bank of Pakistan from where benevolent grant can be paid.
---------------------------------------------12. Head Post Office
from where sum assured be paid.
---------------------------------------------13. Period for which
contribution to Benevolent and Insurance Funds were not paid.
---------------------------------------------14 (a) Four copies of
duly attested photographs of each nominee/or the incapacitated
employee. Enclosed vide Annexure
--------------------------------------------- (b) Four
signatures/thumb impressions on separate sheets (four on each
sheet) of each nominee/ incapacitated employee. Enclosed vide
Annexure ---------------------------------------------
IN CASE OF INCAPACITATED EMPLOYEE ONLY15.(a) Certificate from
the Medical Authority. Enclosed vide Annexure
------------------------- (b) Copy of the order removing/retiring
the incapacitated employee. Enclosed vide Annexure
-------------------------Certified that the information contained
above is correct and checked from the record.
Dated------------------ Head of the DepartmentForwarded to the
Board of Trustees of the Federal Employees Benevolent and Insurance
Funds.
Dated------------------ Head of the
Department(AuthorityNotification No.S.R.O. 2(KE)/72, dated the
4thMarch, 1972)12.21In accordancewiththeFederal Employees
Benevolent Fund & Group Insurance (Amendment) Ordinance, 1988
(Ordinance No. VI of
1988)readwithEstablishmentDivisionNotifications No. S.R.O. 753
(l)/88 &S.R.O. 754(I)88 of4thSeptember, 1988theprovisions
contained in thepreceding paragraph would stand amended w.e.f.4th
September, 1988, to theextent indicate in the succeeding
paragraphs.12.22 "Benevolent grants in he paid from the Benevolent
Fund.-lfanemployee(a)is declared by the prescribed medical
authority to have beencompletely incapacitated physically or
mentally to discharge theduties of-his employment and is for that
reason retired or removedfrom service, he shall beentitledto
receive for life such benevolentgrant fromtheBenevolent Fund as may
be prescribed : or(b)dies during the continuance of his employment,
or duringretirement before attaining the age of seventy years, his
spouseshall be entitled to receive for life such benevolent grant
from theBenevolent Fund as may be prescribed :Providedthat,if the
deceased employee has no spouse or hisspouse has died, the other
members of his family shall be entitledto receive benevolent grant
from the Benevolent Fund for aperiod of fifteen years or up to the
date the deceased employeewould have attained the age of seventy
years, whichever isearlier:Provided further that, in the case of an
employee who diesafter having drawn benevolent grant, the said
period of fifteenyears shall be reckoned from the date from which
he begandrawing such grant,"12.23 Contribution to & benefits
from Benevolent Fund.-The rate ofcontribution to the Benevolent
Fund* and the amount of monthly grantpayable out of the Benevolent
Fund will be as under :Sl. No.Monthly PayRate of monthly
contributionRate of monthly Benevolent Grant
12 (Rs.)3 (Rs.)4(Rs.)
1.501-60011270
2.601-70013300
3.701-80015330
4.801-90017360
5.901-100019390
6.1001-110021420
7.1101-120023450
8.1201-130025480
9.1301-140027510
10.1401-150029540
11.1501-160031570
12.1601-170033600
13.1701-180035630
14.1801-190037660
15.1901-200039690
16.2001-210041720
17.2101-220043750
18.2201-230045780
19.2301-240047810
20.2401-250049840
21.2501-260051870
22.2601-270053900
23.2701-280055930
24.2801-290057960
25.2901-300059990
26.3001-3100611020
27.3101-3200631050
28.3201-3300651080
29.3301-3400671110
30.3401-3500691140
31.3501-3600711170
32.3601-3700731200
33.3701-3800751230
34.3801-3900771260
35.3901-4000791290
36.4001-4100811320
37.4101-4200831350
38.4201-4300851380
39.4301-4400871410
40.4401-4500891440
41.4501-4600911470
42.4601-4700931500
43.4701-4800951530
44.4801-4900971560
45.4901-5000991590
46.5001 and above.1001620
12.24 Subscription to & benefits from Group Insurance
Fund:--- The rate of contribution to the Group Insurance Fund and
the amount of sum assured to be paid to the family of deceased will
be as under.Sl. No.Monthly PayRate of monthly contributionRate of
monthly Benevolent Grant
12 (Rs.)3(Rs.)4(Rs.)
1.501-6007.0020,000
2.601-7008.0523,000
3.701-8009.1026,000
4.801-90010.1529,000
5.901-100011.2032,000
6.1001-110012.2535,000
7.1101-120013.3038,000
8.1201-130014.3541,000
9.1301-140015.4044,000
10.1401-150016.4547,000
11.1501-160017.5050,000
12.1601-170018.5553,000
13.1701-180019.6056,000
14.1801-190020.6559,000
15.1901-200021.7062,000
16.2001-210022.7565,000
17.2101-220023.8068,000
18.2201-230024.8571,000
19.2301-240025.9074,000
20.2401-250026.9577,000
21.2501-260028.0080,000
22.2601-270029.0583,000
23.2701-280030.1086,000
24.2801-290031.1589,000
25.2901-300032.2092,000
26.3001-310033.2595,000
27.3101-320034.3098,000
28.3201-330035.35101,000
29.3301-340036.40104,000
30.3401-350037.45107,000
31.3501-360038.50110,000
32.3601-370039.55113,000
33.3701-380040.60116,000
34.3801-390041.65119,000
35.3901-400042.70122,000
36.4001-410043.75125,000
37.4101-420044.80128,000
38.4201-430045.85131,000
39.4301-440046.90134,000
40.4401-450047.95137,000
41.4501-460049.00140,000
42.4601-470050.05143,000
43.4701-480051.10146,000
44.4801-490052.15149,000
45.4901-500053.20152,000
46.5001-510054.25155,000
47.5101-520055.30158,000
48.5201-530056.35161,000
49.5301-540057.40164,000
50.5401-550058.45167,000
51.5501-560059.50170,000
52.5601-570060.55173,000
53.5701-580061.60176,000
54.5801-590062.65179,000
55.5901-600063.70182,000
56.6001-610064.75185,000
57.6101-620065.80188,000
58.6201-630066.85191,000
59.6301-640067.90194,000
60.6401-650068.95197,000
61.6501 and above70.00200,000
12.25 Life time arrears:----The Benevolent Grant which was not
drawn by the beneficiary during his life shall be paid to his
family members up to Rs.5,000 on production of an Indemnity
Bond:Provided that, the total amount exceeds Rs 5,000 it shall be
paid on production of Succession Certificate.12.26 Discontinuance
of Grant:---(1)The Benevolent Grant shall be discontinued if-(a)an
employee retired on medical grounds under clause (a) of section 13
gets usefully employed or sets up-viable business and his monthly
income exceeds Rs. 700 ; or(b)the recipient of the grant ceases to
be a member of the family as defined in sub-section (5) of the
section 2.(2)The recipient of grant shall be required to furnish a
certificate every quarter that he has not ceased to be eligible for
the grant on account of marriage, employment or setting up business
as the case may be.12.27The revised format of Form B would be as
under: ------FORMBPART 11.(a) Name of the deceased/incapacitated
employee. ----------------------------------------------(b)
Fathers/Husbands name
----------------------------------------------(c) His/her Service
or Department. ---------------------------------------------(d)
Head of the Service or Department.
--------------------------------------------- (e) Station/Place of
last posting. --------------------------------------------- (f)
Last appointment held
---------------------------------------------2. pay per month i.e.
(a)Basic pay (b)Special pay (c)Technical pay (d) Personal pay
(e)Indexation pay (f) 3. Date of Birth
--------------------------------------------4. Date of entry into
Service. --------------------------------------------5. Date of
death (death cases only)
--------------------------------------------6. Date of removal from
service on account of (a)
Incapacitating---------------------------------------------------------
(b)
Retirement------------------------------------------------------------
(c) Death during
service---------------------------------------------------7.
Name/Names of nominee/nominees (Nomination required both in death
and invalid cases).NameAgeRelationshipProfessionMarital
statusMonthly Income
(a)
(b)
(c)
(d)
(e)
(f)
8. Address of nominee(s) of the deceased or incapacitated
employee where correspondence can be made. (In death cases where
there is no nomination similar particular of eligible dependent may
be given).9.Branch of National Bank of Pakistan nearest to the
residence of beneficiary/beneficiaries.10. Period for which
contributions to Benevolent and Group Insurance Funds were not
paid---------------------------------------------------------------PART
II11. Following Documents must be submitted with Claim:(a) Annex
"A"--A copy of last pay certificate by the Head of the Office duly
attested by the Head of Department.(b)Annex "B"--Attested
photostats copy of the page of service book/ document showing date
of birth.(c)Annex "C"--Attested photostats copy of the page of
service book showing date of entry in service.(d)Annex "D"-- (Death
Cases only) three copies of death certificate duly attested. These
may be in the form of office order notifying the death, certificate
by a medical officer or extract from the register of births/death
of Union Council/Union Committee/MunicipalCommittee.(e)Annex "E"--
(Invalid Cases) A copy of the Medical Board proceedings duly
attested by the Head of the Department. Medical Board must comprise
of three Medical Officers one of them being a specialist. Medical
Board proceedings must record the case history and the exact nature
of disability. (See Part IV).(f)Annex "F"-- Nomination form duly
attested.(g)Annex "G"--List of family members and dependent i. e.,
wife/wives, children, father, mother, minor brothers and
unmarried/divorced sisters. The list should indicate name,
relationship, age, marital status, profession, monthly income and
present address.(h) Annex "H"--Wholly dependence certificate (other
than wife and husband) by the Head of Department.(i) Annex
"I"--Envelop containing four copies of photographs duly attested in
respect of each nominee or the incapacitated employee bearing the
name of the person on the reverse of three photos and one on the
face. In case of purdah observing ladies, photographs will not be
required.A certificate that they are Purdah observing must be
attached.(j) Annex "J"--Four signatures/thumb impressions on
separate sheets (four on each sheet) of each
nominee/dependents/incapacitated employee duly attested by the
competent authority.PART IIICERTIFICATE BY THE HEAD OF DEPARTMENT1.
Certified that the information contained above is correct according
to our record.2. Certified that the above named employee is/was
neither a contingency work charged employee or a deputation's from
any Provincial Government. (In case of a deputation's from one
Federal Government Department to another, the case will be
preferred by his parent Department).3. Certified that the employee
died during the continuance of his service (death cases only).4.
Certified that the employee died after retirement before attaining
the age of seventy years (death after retirement cases only).5.
Certified that the above claim has been preferred for the first
time and has not been sent previously.N. B--- Score out which is
not applicable.
Dated: ----------------------- Seal & Signature Head of the
OfficeForward to the Assistant Director, Regional Board, Federal
Employees Benevolent and Group Insurance Funds,
Karachi/Islamabad.
Dated: ----------------------- Seal & Signature Head of the
Department
PART IVINVALIDATION CERTIFICATE FEDERAL EMPLOYEES[See CSR
Articles 442 (d), (e) 443 (a), (b) & (c) and 447]1. IMPORTANT
INSTRUCTIONS(a) All columns must be typed.(b) All columns must be
filled. Those not applicable must be crossed.(c) Head of the
Department is personally responsible for accurate completion of
this form.(d) An individual will not be removed from service until
Head of the Department has approved the Medical Board
proceedings.(e) Medical Board must comprise three members one being
a Specialist.Name------------------------------------------S/o,
D/o,
W/o----------------------------------------------Designation----------------------------------Office--------------------------------------------------------Department--------------------------------------Total
Service--------------------------------------------Age: Per
Statement/documents-----------------------per
appearance----------------------------------Identification
Marks----------------------------------------------------------------------------------------(Left
hand thumb impressions/signatures duly attested).Opinion: (A
detailed statement of medical case and of the treatment adopted as
per CSR 443 (a). If necessary attach documents). Signatures &
Seal of Medical Specialist.2. Opinion of the Medical BoardIn
consequence
of------------------------------------------------------------------------------------------We
consider him/her (name)
----------------------------------------------------------------------------(a)
To be completely and permanently incapacitated for further service
of any kind. (b)Completely and permanently incapacitated for
service in the Department to which he/she belongs.(c)Incapacitated
for service in the appointment which he now holds but we are of the
opinion that he/she is (or may after resting
for---------------months be) fit for further service of less
laborious character than that which he/she has been
doing.(d)His/her degree of
disability---------------------------------------------------------------------(e)His/her
incapacity does/does not appear to have been caused aggravated or
accelerated by irregular or intemperate habits.
Dated: ------------------------ President
------------------------------ (Name, Signature &
Seal)Member--------------------
Member------------------------------(Name, Signature & Seal)
(Name, Signature & Seal)
APPROVED/NOT APPROVED(For partial disability See CSR Article 447
(b).If a person is likely to improve after a certain period he may
be given long leave admissible to him instead of invaliding him out
of service.
Place---------------------------Dated--------------------------
HEAD OF DEPARTMENT, (Name, Signature and Seal)
