(1) It shall be the responsibility of the employer to deduct from the salary of an employee the contributions towards the employee's share under the Scheme and remit the same to the Commissioner in Form PS-5.
(2) Where any employer makes a default in the remittance of any contribution to the Commissioner, the Commissioner shall be competent to recover damages for such delayed remittance on the rates specified in Schedule 4.
(3) Where an employer makes default in remittance of any contribution to the Commissioner, such default in remittance on the part of the employer shall not make any adverse effect on the benefits admissible to an employee under the Scheme.
SCHEDULE 1
[See sub-paragraph (2) of Paragraph 7]
Basis of calculation of amount of reduction
The amounts not deposited to be multiplied by the following factor for the period from the appointed day to the date of superannuation divided by 100.
Example. Rupees 4000 not deposited, the employee superannuates in the year 36[2002]. The period from appointed day to the date of superannuation is 4 years. Factor for more than 4 years is 1.536, so reduction in pension will be
4000 1.536
= 61.40 say Rupees 61.00
100
| Number of years from the appointedday to the date of superannuation |
Factor |
| (1) |
(2) |
| Less than 1 |
1.049 |
| Less than 2 |
1.154 |
| Less than 3 |
1.269 |
| Less than 4 |
1.396 |
| Less than 5 |
1.536 |
| Less than 6 |
1.689 |
| Less than 7 |
1.858 |
| Less than 8 |
2.044 |
| Less than 9 |
2.248 |
| Less than 10 |
2.473 |
| Less than 11 |
2.720 |
| Less than 12 |
2.992 |
| Less than 13 |
3.292 |
| Less than 14 |
3.621 |
| Less than 15 |
3.983 |
| Less than 16 |
4.381 |
| Less than 17 |
4.819 |
| Less than 18 |
5.301 |
| Less than 19 |
5.801 |
| Less than 20 |
6.414 |
| Less than 21 |
7.056 |
| Less than 22 |
7.761 |
| Less than 23 |
8.537 |
| Less than 24 |
9.390 |
SCHEDULE 2
[See sub-paragraph (3) of Paragraph 10]
Basis for determining the pension payable to an employee opting to draw pension before attaining the age of superannuation.
| 37[Period in year(s) for superannuation |
For every Rupees 100 per month payable at age of superannuation, the amount payable to the employee from date of exit |
| 0 |
100 |
| 1 |
97 |
| 2 |
94 |
| 3 |
91 |
| 4 |
89 |
| 5 |
86 |
| 6 |
83 |
| 7 |
81 |
| 8 |
78 |
| 9 |
76 |
| 10 |
73 |
| 11 |
71 |
| 12 |
69 |
| 13 |
66 |
| 14 |
64 |
| 15 |
62 |
| 16 |
60 |
| 17 |
58 |
| 18 |
56 |
| 19 |
54 |
| 20 |
52] |
SCHEDULE 3
[See sub-paragraph (4) of Paragraph 10]
Basis for determining the amount payable to an employee who has not completed ten years of pensionable service.
(A) Entire pensionable service rendered with effect from 1-4-1989:
| Number of years of pensionable service, rounded to the nearest year |
Number of times the monthly salarydrawn on the date of superannuation |
| 1 |
.60 |
| 2 |
1.23 |
| 3 |
1.86 |
| 4 |
2.51 |
| 5 |
3.17 |
| 6 |
3.84 |
| 7 |
4.52 |
| 8 |
5.22 |
| 9 |
5.45 |
(B) Entire pensionable service rendered up to 31-3-1989:
| Number of full year's contribution paidfrom the 38[date of appointment] |
Amount payable on Superannuation Rs. |
| 1 |
110 |
| 2 |
150 |
| 3 |
195 |
| 4 |
245 |
| 5 |
300 |
| 6 |
355 |
| 7 |
415 |
| 8 |
480 |
| 9 |
550 |
(C) Pensionable service rendered partly up to 31-3-1989 and partly after 1-4-1989:
Number of times of monthly salary under A + amount payable under Part B multiplied by deferred payment factor, as in Schedule 1 from the appointed day to the date of superannuation.
SCHEDULE 4
[See sub-paragraph (2) of Paragraph 23]
Rates of damages for delayed remittance
| Default during the year |
One month or less |
Over 1 month and up to 2 months |
Over 2 months and up to 3 months |
Over 3 months and up to 4 months |
Over 4 months and up to 5 months |
Over 5 months |
| 1st default |
2% ofarrears |
5% of arrears |
10% of arrears |
15% of arrears |
20% of arrears |
25% of arrears |
| 2nd default |
5% of arrears |
10% of arrears |
15% of arrears |
20% of arrears |
25% of arrears |
25% of arrears |
| 3rd default |
10% of arrears |
15% of arrears |
20% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
| 4th default |
15% of arrears |
20% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
| 5th default |
20% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
| 6th default |
25% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
25% of arrears |
FORM PS-1
[See sub-paragraph (4) of Paragraph 4]
Option Form
| 1. Name (in block letters) |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 2. Coal Mines Provident Fund Account No. |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 3. Father's/Husband's Name |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 4. Marital status |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 5. Permanent address |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| VillageThana |
: |
. . . . . . . . . Taluk/Sub-Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| Post OfficeDistrict |
|
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| |
|
. . . . . . . . . . . . . . State . . . . . . . . . . . . . . |
| |
|
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 6. Date of birth (in words) |
|
Date . . . . . . . Month . . . . . . . . Year . . . . . |
*I hereby opt for the Coal Mines Pension Scheme, 1998. I authorise diversion of pension contribution at the prescribed rate from my Provident Fund Account. I also undertake to desposit the arrears of the amounts specified in clauses (b), (c), (d) and (e) of Paragraph 3 of the Scheme in terms of the provisions of sub-paragraph (2) of Paragraph 4.
Signature/Thumb Impression
Colliery in which employed.
*I have understood the provisions of the Scheme and hereby do not opt for the Scheme.
Date . . . . . . . . . .
Place . . . . . . . . . .
Signature/Thumb Impression
Colliery in which employed.
Certificate to be signed by Manager or Authorised Officerof the Coal Mine
The provisions of the Scheme and the benefits thereof have been explained to Shri/Smt/Kumari . . . . . . . . . . . . . . . . . . . . . . . in my presence.
Date . . . . . . . . . .
Place . . . . . . . . . .
Signature. . . . . . . . . . . . . . . . . . . . . .
Name . . . . . . . . . . . . . . . . . . . . . . . .
Designation . . . . . . . . . . . . . . . . . . . .
Name of Coal Mine . . . . . . . . . . . . .
Regd. No. . . . . . . . . . Region . . . . . .
* Inapplicable portion should be deleted.
ACKNOWLEDGEMENT
Received from Shri/Smt/Kumari . . . . . . . . . . . . . . employed in . . . . . . . . . . . . . . Colliery, Option Form under sub-paragraph (2) of Paragraph 4 of the Coal Mines Pension Scheme, 1998.
Date . . . . . . . . . .
Place . . . . . . . . . .
Authorised Officer
FORM PS-2
[See sub-paragraph (4) of Paragraph 4]
Option Form
| 1. Name (in block letters) |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 2. Coal Mines Provident Fund Account No. |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 3. Father's/Husband's Name |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 4. Marital status |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 5. Permanent address |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| VillageThana |
: : |
. . . . . . . . . Taluk/Sub-Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| Post OfficeDistrict |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| |
: |
. . . . . . . . . . . . . . State . . . . . . . . . . . . . . |
| |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 6. Date of birth (in words) |
: |
Date . . . . . . . Month . . . . . . . . Year . . . . . |
I have superannuated from the service of . . . . . . . . . . . . . . . . . . . . . Coal mines with effect from . . . . . . . . . . . . . . . . .
I hereby opt for the Coal Mines Pension Scheme, 1998 and undertake to deposit the amounts specified in sub-paragraph (4) of Paragraph 4.
Signature/Thumb Impression . . . . . . . . .
| Date . . . . . . . . . . |
Colliery of last employment |
| Place . . . . . . . . . . |
Regd. No. . . . . . . . . . . . . . . . . . . . . . |
Certificate to be signed by Manager or Authorised Officer of the Coal Mine
The provisions of the Scheme and the benefits thereof have been explained to Shri/Smt/Kumari . . . . . . . . . . . . . . . . . . . . . . . in my presence.
Date . . . . . . . . . .
Place . . . . . . . . . .
Name . . . . . . . . . . . . . . . . . . . . . . . .
Signature. . . . . . . . . . . . . . . . . . . . . .
Designation . . . . . . . . . . . . . . . . . . . .
Name of Coal Mine . . . . . . . . . . . . .
Regd. No. . . . . . . . . . . . . . . . . . . . . .
ACKNOWLEDGEMENT
Received from Shri/Smt/Kumari . . . . . . . . . . . . . . last employed in . . . . . . . . . . . . . . Colliery, Option Form under sub-paragraph (4) of Paragraph 4 of the Coal Mines Pension Scheme, 1998.
Date . . . . . . . . . .
Place . . . . . . . . . .
Authorised Officer
FORM PS-3
[See sub-paragraphs (1) and (2) of Paragraph 5]
Particulars of Family
| 1. Name (in block letters) |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 2. Coal Mines Provident Fund Account No. |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 3. Father's/Husband's Name |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 4. Marital status |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 5. Permanent address |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| VillageThana |
: : |
. . . . . . . . . Taluk/Sub-Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| Post OfficeDistrict |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| |
: |
. . . . . . . . . . . . . . State . . . . . . . . . . . . . . |
| |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 6. Date of birth (in words) |
: |
Date . . . . . . . Month . . . . . . . . Year . . . . . |
The particulars of my Family are as follows:
| Sl. No. |
Name of family members |
Relationship with employee |
Date of birth* |
| 1 |
|
|
|
| 2 |
|
|
|
| 3 |
|
|
|
| 4 |
|
|
|
| 5 |
|
|
|
*(Where exact particulars are not available approximate age may be indicated in consultation with the M.O. of the Coal Mines.)
I hereby certify that the particulars given above are correct to the best of my knowledge.
(Signature or thumb impression)
Date . . . . . . . . . .
Place . . . . . . . . . .
Certified that the above statement has been signed/subscribed by Shri/Smt/Kumari . . . . . . . . . . . . . . . employed in . . . . . . . . . . . . . . . . . . . Colliery in my presence. He/she has read the above particulars/above particulars have been read over to him/her by me.
(Signature of the Manager/Authorised Officer)
Designation . . . . . . . . . . . . . . . . . . . . . .
Name and address
of the Colliery . . . . . . . . . . . . . . . . . . . .
Date . . . . . . . . . . . Regd. No. . . . . . . . . . . . Region . . . . . . .
FORM PS-4
[See sub-paragraphs (1) and (2) of Paragraph 5]
Nomination Form
| 1. Name (in block letters) |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 2. Coal Mines Provident Fund Account No. |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 3. Father's/Husband's Name |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 4. Marital status |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| 5. Permanent address |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
Village . . . . . . . . . . . . . . . . . . Post Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Police Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
District . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Date of birth (in words) : Date . . . . . . . . . . Month . . . . . . . Year . . . .
(@) I hereby nominate the person/persons as follow to receive the outstanding benefits on my death in service.
(@) I hereby cancel the nomination made by me earlier and make fresh nomination as follows to receive the outstanding benefits on my death in service.
(@) Delete whichever is not applicable.
| Name and Address of the nominee or nominee(s)in block letters |
Nominee's relation with the employee |
Date of birth of the nominee |
Amount of Share |
| |
|
|
|
Signature or Thumb Impression
* I hereby declare that in the event of my death during the minority of above-named nominee(s) the person whose particulars are as follows shall be the guardian of the minor nominee(s).
* I hereby cancel the earlier declaration of the guardian made by me and further declare that in the event of my death during the minority of my above-named nominee(s) the person whose particulars are as follows shall be the guardian of the minor nominee(s).
| Name and Address of the Guardian |
Age of the Guardian |
Relationship of the Guardian with the employee |
| |
|
|
Certified that the above declaration has been signed by . . . . . . . . . . . . . . . . . . . . employed in the . . . . . . . . . . . . Colliery in my presence. He/she has read the above particulars/above particulars have been read over to him/her by me.
Regd. No. of Coal Mine . . . . . . . . . . .Signature of the Manager or other Officers
Date . . . . . . . . . . . . . . . . . . . . . . .Signature . . . . . . . . . . . . . . . . . . . . . .
Name and Address of the Coal Mines
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
* Delete whichever is not applicable.
FORM PS-5
[See sub-paragraph (1) of Paragraph 8]
Monthly abstract of contributions towards Pension Fund and Provident Fund for the month of . . . . . . . . . 1998
(To be submitted to the Commissioner in triplicate by 30th day of every month by registered post or through a messanger along with the original Bank receipt/Cheque/Draft towards the contributions)
1. (a) Total amounts of salary of the employees . . . . . . . . . . . . . . . . . . . .
(b) Total notional salary of the employees . . . . . . . .
2.
| Month |
Compulsory contributions towards CMPF excluding the amounts of contributions to be transferred to the Pension Fund |
Voluntary contribu-tions of the employees towards CMPF |
Pension contribu-tion to be transferred |
Two per cent additional contribution on total *notional salary of the employees |
Amounts of one increment |
Under/over charge |
*Upto 31-3-1996 on total salary paid and from 1-4-1996 on notional salary payable.
3. Add on account of under charges
4. Deduct on account of over charges
5. Administrative charges of three per cent on gross compulsory contribution towards Provident Fund in terms of the provisions of Provident Fund Scheme
6. Total amount of contribution and administrative charges Rs . . . . . . . . . . . . . .
7. Amount of Bank collection charge Rs . . . . . . . . . . . . . .
8. Total amount of remittance Rs . . . . . . . . . . . . . .
@(i) (Deposited Rs . . . . . . . . . . under Provident Fund Cash Receipt No. . . . . . . . . . . . dated . . . . . . . . .)
@(ii) (Deposited Rs . . . . . . . . . . in the State Bank of India, Dhanbad 39[or any other Nationalized/Scheduled Bank] Account No. 1 (Receipted Pay-in-slip Attached.)
@(iii) Remitted Rs . . . . . . . . . vide crossed account payee cheque/crossed account payee draft No. . . . . . . . . . . . . . . dated . . . . . . . . . . . . on the . . . . . . . . . . . . in favour of Coal Mines Provident Fund Account No. 1 (Cheque or Draft attached).
Dated . . . . . . . . . 20
MANAGER
. . . . . . . . . . COLLIERY
C.M.P.F. Regd. No. . . . . . . . .
ZONE . . . . . . . . . . . . . . . .
@ Delete the portion which is not applicable.
FORM PS-6
[See sub-paragraph (1) of Paragraph 15]
Application for different benefits
1. Name (in block letters) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Coal Mines Provident Fund Account No. : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Father's/Husband's Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. (a) Permanent address of the claimant . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Village . . . . . . . . . . . . . . . . . . Post Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Police Station . . . . . . . . . . . . . Distt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(b) Permanent address of the claimant . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Village . . . . . . . . . . . . . . . . . . Post Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Police Station . . . . . . . . . . . . . Distt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Date of birth (in words) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date . . . . . . . . . . . . . . . . . . . Month . . . . . . . . . . . . . . . Year . . . . . . . . . . . . . . . . . . .
7. Date of initial employment : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Date of cessation of employment : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Cause of cessation of employment : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Name of claimant : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Relationship of the claimant with the employee : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Whether the claim is for self or on behalf of minor child of the deceased employee : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Kind of Pension admissible : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14. Name of establishment/colliery where the employee was employed from 1-3-1971 or from the date of joining whichever is later
Period
Colliery
FromTo
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
15. Period of absence without wages during last 10 months
Period fromtoNo. of days
(i)
(ii)
(iii)
(iv)
(v)
16. Whether period of absence without pay has been regularised by the Competent Authority.
17. Average emoluments during the last 10 months Rs . . . . . . . . . . . (detailed statement to be attached with number of days for which wages paid).
18. Whether employee desires to receive Pension before attaining the age of superannuation. If yes, option under the provisions of sub-paragraph (3) of Paragraph 10 has been attached or not.
19. Whether employee desires to receive pension under the provisions of sub-paragraph (1) of Paragraph 15 of the Scheme. If yes, his option has been attached or not.
20. In case of disablement pension whether the declaration of the competent Medical Board has been attached or not.
21. Details of Family:
| Name |
Date of birth |
Name of guardian in r/o minor child/children with full address |
| Wife |
|
|
| Sons below 25 years |
|
| (1) |
|
|
| (2) |
|
|
| (3) |
|
|
| Unmarried daughters below 25 years |
| (1) |
|
|
| (2) |
|
|
| (3) |
|
|
| (4) |
|
|
| Nominee with full address |
22. Mode of payment : . . . . . . . . . . . . . . . . . . . . . . . . . . . .
| (a) |
Name of the Bank SB A/c No. (in words)(in figures)OR |
: |
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| (b) |
Post Office-Branch SB A/c No. (in words)(in figures)OR |
: |
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| (c) |
M.O. on the cost of payee Full address OR |
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| (d) |
Office of the Authorised Officer |
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Option to be exercised by the employee at the time of submission of claim ofpension under the Coal Mines Pension Scheme, 1998
I . . . . . . . . . . . . . . . . . . . . S/o . . . . . . . . . . . . . . . . . holder of CMPF A/c No. . . . . . . . . . . . . . . . employed in . . . . . . . . . . . . . . . (colliery) hereby opt:
*(1) to draw pension w.e.f. . . . . . . . . . . . . . . . . at the age of . . . . . . . . . . . . . . . years, i.e., earlier than superannuation age under the provisions of sub-paragraph (3) of Paragraph 10 of the Scheme.
OR
*(2) to draw full admissible amount of pension under clause (a) of sub-paragraph (1) of Paragraph 15 of the Scheme.
OR
*(3) to draw reduced pension during my life time under the provisions of clause (b) of sub-paragraph (1) of Paragraph 15 of the Scheme.
OR
*(4) to draw reduced pension during my life time under the provisions of clause (c) of sub-paragraph (1) of Paragraph 15 of the Scheme.
*(Strike out the option not applicable.)
I declare that I have fully understood the provisions of the Scheme and understand that the option once exercised will be final and I shall have no right to modify it.
Signature/Right thumb impression/
Date:Left thumb impression of the employee
Place:
Countersigned
Date:Signature
Place:Colliery Manager:
Official Seal
DECLARATION
I hereby declare that the above particulars are true to the best of my knowledge.
I declare that I have not remarried after . . . . . . . . . . . . . . . (insert the date of death of employee).
I declare that I have not attained the age of 25 years (in the case of son).
I declare that I have not married and have not attained the age of 25 years (in case of daughter).
(Strike out if not applicable.)
DateSignature/Left thumb impression
Place:Right thumb impression of claimant
(To be Completed by the Colliery Manager)
Certified that Shri/Smt/Kumari . . . . . . . . . . . . . . . . . . . . . . . . . . . . . wife/son/daughter of L/. . . . . . . . . . . . . . . . . . . . . is known to me/has been identified before me by . . . . . . . . . . . . . . . . . . . whom I know since last . . . . . . . . . . . . . . . . . . years . . . . . . . . . . . . . . . . . . . . . months and that he/she signed/affixed LTI/RTI before me and that to the best of my knowledge and belief the particulars furnished in the claim are correct.
Signature/Thumb impressionSignature of the of the claimantColliery Manager
Designation Address and Official Seal
Signature of the Identifierwith full details
Date:
Place:
Certificate by the Colliery Manager
Certified that the particulars of the employee and that of his/her family are correct in accordance with the service records maintained by the Colliery Management.
Certified that full contributions as required under the provisions of the Scheme have been recovered and remitted to the C.M.P.F. Commissioner, Dhanbad.
Date:Signature of the Colliery Manager
Place:Official Seal