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Delhi Development Authority

Personnel Branch –V

Set of Documents applying

for Appointment on

compassionate grounds

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INDEX

1. Format of written application to be submitted by the widow/legal heir of deceased employee. (To be submitted duly diarized in the office of the

controlling officer/DDO of the deceased employee).

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2. Instructions for controlling officer/DDO.

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3. Annexure ‘A’ ( PART-A) Performa regarding employment of dependents of DDA employee dying while in service/ retired on invalid pension.

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4. Annexure ‘B’ ( PART –B) To be filled up by the controlling officer/ Branch Officer.

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5. Annexure ‘C’ Specimen of affidavit from the applicant.

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6. Annexure ‘D’ Specimen of No objections in shape of affidavit from

other legal heirs of deceased employee.

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***********

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To

The __________________________________________(DDO/Controlling officer)

_____________________________________________ _____________________________________________

Sub: Request for appointment on compassionate grounds after the death of

Sh/Smt._________________________________son/wife/daughter of Late Shri_____________________________________working as _________________ on Temp./ Permanent/Regular/ W/C-Regular basis.

******************** Sir,

With due respect, I am to state that my father/mother /husband Late Sh/Smt._______ ______________________son/wife of Shri______________________________________ working ________________________________in your Division/Office) had expired on __________________.

2. I am submitting the following document and applying for appointment on

compassionate grounds duly attested by Notary Public/ Gazetted Offer. (a) Form Part –A ( as per annexure ‘A’) (b) Original Death Certificate. (c) Copy of Death Notification. (d) Copy of Ration Card duly attested showing the name of the applicant and deletion of

the name of the deceased. (e) Affidavit ( as per specimen at Annexure ‘C’). (f) Affidavit / No Objection certificate (as per specimen at Annexure ‘D”). (g) Photocopies of documentary proof of date of birth, Educational Qualifications/ School

Leaving Certificates/ Birth certificate in respect of applicant and each legal heirs. (h) Three Passport size Photographs of the applicant duly attested by the DDA/

Controlling Officer. (i) Cast Certificate, ( in case of SC/ST/OBC category) . (j) Disability Certificate issued by the Medical Board constituted by the Central or State

Govt. (in case of persons with Disability category). Encls: As stated.

Yours faithfully

Signature of the applicant

Name of the applicant_____________________________________ (in capital Letters)

Son/wife/daughter of Late Sh.______________________________ Postal Address:__________________________________________ ______________________________________________________

Permanent Address:______________________________________ ______________________________________________________ ______________________________________________________ Contact No.____________________________________________

(Telephone / Mobile No. if any)

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INSTRUCTIONS FOR CONTROLLING OFFICER/

DRAWING & DISBURSING OFFICER. (Formalities to be completed by Controlling Officer/DDO.)

…………………………………………

Application in prescribed Form (Part A & B annexed as annexure „A‟ &

„B‟) seeking appointment duly recommended & completed be got

diarized and placed in a separate file with the following documents.

The documents should be checked and verified from the service book

by the DDA and a certificate to this effect that the contents of Form A &

B have been checked from the service book and found correct should

be recorded.

1. Original Death Certificate issued by Municipal Authorities or other

Competent Authority.

2. Copy of Death Notification showing the date of death & date of birth

of deceased employee issued by the Competent Authority.

3. Each & Every page of the photocopy of Service Book of the

deceased should be attested by DDO/Controlling Officer.

4. DDO/Controlling Officer should duly attest entry of Death Notification

as well as Paid Death Benefits in the Service Book.

5. Upto date service verification of the deceased by the Controlling

officer/Drawing & Disbursing Officer.

6. Copy of Ration Card duly attested showing the name of the

applicant and deletion of the deceased name.

7. Affidavit from the applicant on non-judicial stamp paper of Rs. 10/-

(as per specimen at “Annexure –C” duly attested by the 1st class

Magistrate or Notary Public.

8. Affidavit /No Objection certificate on non-judicial stamp paper of Rs.

10/- duly attested by the 1st class Magistrate or Notary Public from

major legal heirs in favour of applicant. (as per specimen at

“Annexure –D” ( Please note that every major legal heir will submit

separate No Objection certificate).

9. Photocopies of documentary proof of Date of Birth, Educational

Qualifications/School Leaving Certificate/ Birth Certificate duly issued

by the Municipal Authorities etc. in respect of applicant & each legal

heirs.( In case of illiterate family member, the date of birth can also be

declared through affidavit ( Annexure‟C‟).

10. Three Passport size photographs of the applicant duly attested by the

DDO/Controlling Officer.

11. In Case of SC/ST/OBC applicant, copy of Cast certificate issued by

the competent authority duly attested should be attached.

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12. If the applicant is Physically Handicapped, an attested copy of

certificate of disability issued by the Medical Board constituted

by the Central/State Government should be placed in the file.

Note:

1. Cases of Regular Staff are required to be sent to Dy. Director (P) V directly, after completing all the codal formalities as mentioned above.

2. Cases of Work-Charged or Work Charged (Regular) Staff: to be routed through Director (Estt.) Work-Charged after completing the requisite codal formalities.

………………………….

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Annexure - A PROFORMA REGARDING EMPLOYMENT OF DEPENDENTS OF DDA EMPLOYEE DYING WHILE IN SERVICE/RETIRED ON INVALID PENSION PART A Description

1(a) Name of DDA employee (Deceased/retired on medical grounds.

(b) Designation of the DDA employee.

(c) Whether Permanent/Temporary/Regular/W/C-Regular.

(d) Whether it is Group “D” or not?

(e) Department/Branch where the employee was working at the time of death/retirement on medical grounds.

(f) Date of death/retirement on medical grounds.

(g) Date of birth of deceased/retired employee.

(h) Age of DDA employee on the date of death/retirement on medical grounds.

(i) Total length of service rendered.

(j) Whether the applicant belongs to SC/ST/OBC? If yes, necessary certificate issued by competent authority be enclosed.

II (a) Name of Applicant for Appointment on Compassionate grounds.

(b) Applicant’s relation with DDA employee/retired on medical grounds.

(c) Date of birth of the applicant with documentary proof showing date of birth.

(d) Educational qualifications of the applicant (Enclose attested copies of certificates).

(e) Whether any other dependent family member has been appointed on compassionate grounds? (If yes, give full details).

III Particulars of total assets left by the deceased/retired DDA employees including amount of :-

(a) Family Pension (b) Death Retirement Gratuity (c) GPF balance (d) GIS (e) Benevolent Fund (f) Leave Encashment (g) Life Insurance Policies(Postal Life

Insurance) (h) P.A.I.P (i) Movable/immovable properties and other

income earned there from by the family. (j) Any other properties/assets

Total:-

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IV Brief particular of liabilities, if any.

V Particulars of all dependent family member of the DDA employees/retired on medical grounds (If some are employed, their income and whether they are living together or separately)

S.NO. Name(s) Relationship with the DDA employee

Age Present residential address

Employed or not (if employed, Particulars of employment and emoluments)

(1) (2) (3) (4) (5) (6)

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DECLARATION/UNDERTAKING 1. I_______________Wife/son/daughter of late ______________________resident of

___________________________________________________hereby declare that the facts given by me above are, to the best of my knowledge, correct. If any of the facts herein mentioned are found to be incorrect or false at a future date, my services may be terminated.

2. I hereby also declare that I shall maintain property the other family members who were dependent on the Govt. servant mentioned against 1(a) of Part A of this form and in case it is proved at any time that the said family members are being neglected or not being property maintained by me, my appointment may be terminated.

Signature of the applicant

This is to certify that Sh/Smt./Kumari______________________________________________ son/wife/daughter of Sh./Smt.__________________________________________________is the legal heir of late Sh.___________________________________Designation______________________ (to be certified on the basis of declarations and documents) that the contents/particulars/ information given in Col. I & III of Form Part ‘A” have also been verified from the Service Book of deceased /retired employee & found correct. Signature of DDO/Br. Officer with Date:______________________________________________ Name & Designation( with rubber stamp)_____________________________________________ Address of the Office:____________________________________________________________ Telephone No.:___________________________________________ I have verified the facts mentioned above by the applicant & are correct. Date:______________ Signature of Welfare Inspector Name:__________________________________

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Annexure ‘B’ PART-B

(TO BE FILLED UP BY THE CONTROLLING OFFICER/ BRANCH OFFICER) …………………………………..

I(a) Name of the candidate for appointment

(b) His/her relationship with the DDA employee.

(c) Residential Address & Telephone /Mobile No.(if any) (with documentary proof.)

(d) Age / date of Birth

(e) Educational qualification.

(f) Experience, if any

(g) Post for which employment is proposed and whether it is Group ‘C’ or ‘D’

(h) Whether the applicant fulfills the conditions/ requirement of the post?

II Whether the facts mentioned in Form Part-A have been verified and if so, indicate the record.

III If the Government servant died/ retired on medical grounds more than 5 years back, why the case was not sponsored earlier?

IV Personal Recommendations of Branch Officer/ Controlling Officer/DDO

Signature of Br. Officer/Controlling Officer/DDO

( with date & rubber stamp)

Counter Signature of Competent authority

( with date & rubber stamp)

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Annexure- ‘C’ ( This affidavit shall be given on non-judicial stamp paper of Rs. 10/- only duly

attested by Ist Class Magistrate or Notary Public)

Affidavit from applicant

I, _____________, wife/son/daughter of late Sh. ------------------, r/o House No.

_______________________________________________ do hereby solemnly affirm and declared as under:

2. That, I am the legally wedded wife/son/daughter of late Shri/Smt..___________, who was

working in DDA as ------ Temp./ Permanent / W/C (Regular)/Regular Estt. in the office of the

____________, New Delhi & expired on-----. The deceased had left behind the following legal

heirs/ Family members:

S.No. Name Age or

date of

birth

Relation with

deceased

marital status Educational

Qualification Employed or un-

employed

1.

2.

3.

4.

5.

3. That there are no legal heirs in the family except the members indicated in para 2 above.

4. That none of the family member including myself as mentioned above is in employment of any

Govt./Semi -Govt./ Private Service/ business

OR

That the legal heir(s) mentioned at S.No.________________above is/are employed/working

in______________(Name of organization/department).

5. That I have not re-married after the death of my husband (in case, the applicant is widow)

6. That I am applying for appointment on compassionate ground after the death or retirement on

medical grounds of my husband/father/mother Shri/Smt._________________& other legal heirs

have also given their NOCs in my favour.

7. That I am not in occupation of DDA Staff Qtr.

OR

That I am still in occupation of DDA Staff Qtr. No._________ at ________________, New Delhi.

Deponent

Verification:-

Verified at ____________ on this _____day of _________20 __ that the contents

mentioned above are true to the best of my knowledge and belief and nothing has been

concealed/suppressed. If at any later stage, any concealment is found on my part, then it will be a case

of mis-representation & concealment of facts. In that event, my appointment on compassionate

grounds would be liable to be terminated.

Deponent

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Annexure- ‘D’

(This NOC in shape of affidavit shall be executed on non-judicial stamp paper of Rs.10/- only & separate affidavit shall be submitted

by each major legal heirs (inclusive of married daughters) who attained the age of 18 yrs. The affidavit should be attested by Notary

public or Ist class Magistrate)

Affidavit/ NOC

I, _____________, wife/son/daughter of late Sh. ------------------, r/o House No.

____________New Delhi, do hereby solemnly affirm and declared as under:

2. That, I am legally wedded wife/son/daughter of late Shri/ Smt.___________, who was working in

DDA as ------on Temp. /Permanent/ W/C (Regular) /Regular Estt in the office of the

____________, New Delhi & expired on-----. The Deceased had left behind the following legal

heirs (Family members):

S.No. Name Age or

date of

birth

Relation with

deceased

marital

Status

Educational

Qualification Employed or un-

employed

1.

2.

3.

4.

5.

6.

7.

8.

3. That there are no legal heirs, except the members shown in para 2 above.

4. That I -------- mother/father/wife/son/daughter of late Shri/Smt --------( for self & on

behalf of minor children shown at S.No._______ above)( if applicable) do hereby relinquish my

right for appointment on compassionate grounds in favour of Sh/Smt./Kumari____________

legal heir of late Sh.___________( deceased employee of DDA).

5. That l will not claim appointment on compassionate grounds at a later date.

6. That I have no objection if appointment on compassionate grounds is given to

Sh/Smt./Km.______________son/wife/daughter of late Sh._______________by the DDA.

7. That none of the family member including myself as mentioned above is in employment of any

Govt./Semi –Govt./ Private Service/business.

OR

That the legal heirs mentioned at S.No.______________ above is/are employed/ working

in__________________________ (Name of organization/ department).

8. That I have not re-married after the death of my husband (in case, the applicant is widow )

Deponent

Verification:

Verified at ____________ on this day _________ of _______, 20__ that the contents mentioned

above are true to the best of my knowledge and belief and nothing has been concealed/suppressed.

Deponent

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