© Aryavart Bank Head Office, A-2 /46, Vijay Khand, Gomti Nagar, Lucknow. (AN UNDERTAKING OF GOVT OF NDIA, U.P. GOVT. & BANK Ref. No. HO/PERS & I.L./AKV Circular No. 01/34 Date: 01-04-2019 ‘The General Manager ‘GMO, Lucknow/Aligarh/Banda ‘The Regional Managers All Regional Offices The Chief Managers All Departments, Head Office & GMOs ‘The Branch Managers/Chief Managers, All Branches Re: Scheme for Appointment on Compassionate Ground or Payment of Ex-gratia (Lump-sum amount) in lieu of Compassionate Appointment Its informed that the provision of payment of Ex-Gratia (Lump-sum) amount to legal heirs/P.F. Nominee of deceased staff members in lieu of compassionate appointments was available in both the erstwhile Banks viz. Allahabad UP Gramin Bank and Gramin Bank of Aryavart. The said scheme was implemented in the RRBs as per guidelines received from NABARD vide letter No. 'NB/IDD/RRCBD/563/316 (GEN) dated 13.07.2006. In terms of NABARD letter ref. no NB.IDD.RRB/1216/316 (Compassionate Appoint.) / 2018-19, dated 09 January 2019, informing that the Government of India, Ministry of Finance, Department of Financial Services, New Delhi vide letter no. F. No.7/38/2014-RRB dated 31° December, 2018 have accorded their approval for implementation of the revised Model Scheme for appointment on compassionate grounds in RRBS as per scheme in Public Sector Banks circulated by IBA to CEOs of PSBs vide its letter No. CIR/HR & IR/ 2014-15/532/476 dated 11.08.2014, the erstwhile Allahabad UP Gramin Bank had already implemented the above scheme on 08.02.2019 with the approval of their Board. Accordingly, with the amalgamation of erstwhile Gramin Bank of Aryavart and erstwhile Allahabad UP Gramin Bank, the newly formed Board of Directors of newly constituted Aryavart Bank, in 1 Board meeting dated 01.04.2019 have approved the Scheme for Compassionate Appointment or Payment of Ex-gratia (Lump-sum amount) in lieu of appointment on compassionate grounds. Accordingly, the above scheme is effective from 01.04.2019 in Aryavart Bank. {tis also informed that over the period, from time to time any amendments in the above Scheme ‘may also be treated as part and parcel of above scheme. The salient features, claim and proposal forms for proper implementation of the scheme are enclosed for your information. Please bring the contents of this circular to the knowledge of each staff member of your Office/Branch. GENERAL MANAGER Encl: AR ~ Regulations for Appointment on Compassionate Ground with Application Format Regulations for PAYMENT OF EX-GRATIA LUMPSUM AMOUNT IN LIEU OF APPOINMENT ON COMPASSIONATE GROUNDS with Application FormatsAryavart Bank Head Office, A-2 /46, Vijay Khand, Gomti Nagar, Lucknow. (AN UNDERTAKING OF GOVT OF INDIA, U.P. GOVT, & BANK OF INDIA| Revised Scheme for Appointment on Compassionate ground/Payment of Ex-gratia 1. COVERAGE 1 To a dependent family member of a permanent employee of the Bank who- a) dies while in service (including death by suicide) b) Is retired on medical grounds due to incapacitation Medical Board in a Government Medical College/Government District. Head Quarter Hospitals/Panel of Doctors nominated by the Bank for the purpose. 1.2 For the purpose of the Scheme, “employee” would mean and include only a confirmed regular employee who was serving full time or part-time on scale wages, at the time of death/retirement on medical grounds, before reaching age of 55 years and does not include any one engaged on contract/ temporary /casual or any person who is paid on commission basis. 2. DEPENDENT FAMILY MEMBER 21 Spouse; or 2.2 Wholly dependent son (including legally adopted son); or 2.3 Wholly dependent daughter (including legally adopted daughter); or 2.4 Wholly dependent brother or sister in the case of unmarried employee. 3, AUTHORITY COMPETENT TO MAKE COMPASSIONATE APPOINTMENT 3.1 Chairman. 3.2 Board of Directors in special types of cases. 3.3 While dealing with proposals for appointment on compassionate grounds in otherwise eligible cases, where disciplinary action was pending against the deceased employer/employee retired on medical grounds or if the deceased employee was involved in serious financial irregularities, embezzlement of funds, committing frauds, etc. Bank will continue to abide by the guidelines issued by the Government of India, requiring consideration and decision in each case by the Board of the Bank/ Authority appointed by the Board, 4. POSTS TO WHICH APPOINTMENTS CAN BE MADE 4.1 The appointment shall be made in the clerical and sub-staff cadre only. Page 1 of 65. ELEGIBILITY 51 The family is indigent and deserves immediate assistance for relief from financial destitution; and 5.2 Applicant for compassionate appointment should be eligible and suitable for the post in all respects under the provisions of the relevant Recruitment Rules. 6. EXEMPTIONS 6:1 Compassionate Appointment under the Scheme are exempted from observance of the following requirements: 6.1.1 Normal Recruitment Procedure ie, without the agency of selection like IBPS/Employment Exchange, Recruitment Boart of Bank, etc. 6.1.2 The ban orders on filling up of posts issued by Government of India or any controlling authority. 7. RELAXATIONS 7.1 Upper age limit may be relaxed wherever found to be necessary. The lower age limit should, however, in no case be relaxed below 18 years of age. Note-1: Age eligibility shall be determined with reference to the date of application and not the date of appointment; Note-2: Authority competent to take a final decision for making compassionate appointment ina case shall be competent to grant relaxation of age limit also for making such appointment) 8, TIME LIMIT FOR CONSIDERING APPLICATIONS 8.1 Application for employment under the Scheme from eligible depending should normally be considered upto five years from the date of death or retirement on medical grounds and decision to be taken on merit in each case, 8.2 However, bank can consider request for compassionate appointment even when the death or retirement on medical grounds of the employee took place long back, even five years ago. While considering such belated requests, it should, however, be kept in view that the concept of compassionate appointment is largely related to the need for immediate assistance to the family of the employee in order to relieve it from economic distress. The very fact that the family has been able to manage somehow all these years should normally be taken as adequate proof that the family had some dependable means of subsistence. Therefore, examination of such cases would call for «a great deal of circumspection. The decision to make appointments on compassionate grounds in such cases may, therefore, be taken only at the Board level. Page 2of 69, DETERMINATION/AVAILABILITY OF VACANCIES 91 Appointment on compassionate grounds shall be made only on regular basis and that too, only if regular vacancies meant for that purpose are available. 9.2 Compassionate appointment shall be made upto a maximum of 5% of vacancies falling under direct recruitment quota in the sub-clerical cadre or vacancies identified in the sub-staff category. The Bank shall hold back 5% of vacancies in the aforesaid categories to be filled by appointment on compassionate grounds. A person selected for appointment on compassionate grounds should be adjusted in the recruitment roster against appropriate category, viz., SC/ST/OBC/General Category, depending ‘upon the category to which he/she belongs. 9.3 Widow appointed on compassionate ground upon re-marriage will be allowed to continue in service, even after re-marriage. 10. WHERE THERE IS AN EARNING MEMBER 10:1 In deserving. cases, even when there is already an earning member in the family, a dependent family member may be considered for compassionate appointment with the prior approval of the competent authority of the bank who, before approving such appointment, will satisfy himself that grant of compassionate appointment is justified, having regard to the number of dependents, assets and liabilities left by the employee, income of the earning member as also his/her liabilities, including the fact that the earning member is residing with the family of the employee and whether he/she should not be a source of support to other members of the family. 10.2 In cases where any member of the family of the deceased or medically retired employee is already in employment and is not supporting the other members of the family of the deceased employee, extreme caution has to be observed in ascertaining the economic distress of the members of the family of the deceased employee so that, the facility of appointment on compassionate ground is not circumvented and misused by putting forward the ground that the member of the family already employed in not supporting the family. ‘11. MISSING EMPLOYEE Cases of missing employees are also covered under the scheme for compassionate appointment subject to the following conditions:- 11.1 A request to grant the benefit of compassionate appointment can be considered only after a lapse of at least 2 years from the date from which the Employee has been missing, provided that: (@ an FIR to this effect has been lodged with the Police, (@) the missing person in not traceable, and i) the competent authority feels that the case is genuine; 11.2 This benefit will not be applicable to the case of an Employee: (@) who has less than two years to retire on the date from which he has been missing; or (ii) who is suspected to have committed fraud, or suspected to have joined nay terrorist organization or suspected to have gone abroad. Page 3 of 611.3 Compassionate appointment in the case of a missing employee also would not be a matter of right as in the case of others and it will be subject to fulfillment of all the conditions, including the availability of vacancy, laid down for such appointment under the scheme; 11.4 While considering such a request, the result of the Police investigation should also be taken into account; and 115 A decision on any such request for compassionate appointment should be taken only at the level of the Chairman of the Bank. 12, PROCEDURE a) The prescribed proforma (As in annexure) shall be used by the bank for ascertaining necessary information and processing the cases of compassionate appointment, b) The Officer from the Staff Welfare Department of the bank shall meet the members of the family of the employee in questions immediately after his death to advise and assist to them in getting appointment on compassionate ground. The applicant shall becalled in person at the very first stage and advised in person about the requirements and formalities to be completed by him/her. (©) An application for appointment on compassionate ground shalll be considered by the Committee of officers consisting of three officers; One Chairman of the Bank, General Manager, Head Office and Chief Manager, Pers & IL Department, Head Office shall be members of the committee. The committee shall meet during the second week of every month to consider cases received during the previous month. The applicant may also be granted personal hearing by the committee, if necessary, for better appreciation of facts of the case. The recommendation of the committee shall be placed before the competent Authority for a decision. If the competent Authority disagrees with the committee's recommendation, such cases may be referred to the board for a decision. 13. UNDERTAKING FOR MAINTENANCE OF THE FAMILY OF THE DECEASED EMPLOYEE ‘The person appointed on compassionate grounds under the scheme, should give an undertaking in writing as per (as in Annexure) that he/she will maintain properly the other family members, who were dependent on the deceased employee in question, and incase itis proved subsequently (at any time) that the family members are being neglected or are not maintained properly by him/her, his or her appointment may be terminated forthwith. This clause shall be incorporated as one of the conditions in the offer of appointment applicable only in the case of appointment on compassionate ground. 14. REQUEST FOR CHANGE IN POST/PERSON When a person has been appointed on compassionate ground to a particular post, the set of circumstances, which led to such appointment should be deemed to have caused to exist. Therefore - Page 4 of 615. 16. 17. a) He/she should strive in his/her career like his/her colleagues for future advancement and any request for appointment to any higher post on considerations of compassion shall invariably be rejected. b) Anappointment on compassionate ground cannot be transferred to any other person and any request for the same on consideration of compassion shall invariably be rejected. SENIORITY A person appointed on compassionate ground in a particular year shall be placed at the bottom of all the candidates recruited/ appointed through direct recruitment, promotion ‘tc. in the year, irrespective of the date of joining of the candidate on compassionate ground. TERMINATION OF SERVICE The compassionate appointment can be terminated on the ground of non-compliance of any condition stated in the offer of appointment after providing an opportunity to the compassionate appointee by way of issue of show cause notice asking him/her to explain why his/her services should not be terminated for non-compliance of condition(s) in the offer of appointment and it is not necessary to follow the procedure prescribed in the disciplinary Action and procedure therefor. In order to check its misuse, the power of termination of service for non-compliance of the conditions in the offer of compassionate appointment shall vest only with the Chairman of the Bank. GENERAL. (Appointment made on grounds of compassion shall be done in such a way that persons appointed to the post do have the essential educational and technical qualifications and experience required for the post consistent with the requirement of maintenance of efficiency of administration. (i) Itis not the intention to restrict employment of a family member of the deceased or medically retired sub-staff employee to an erstwhile sub-staff post only. As such a family member of such erstwhile sub-staff employee can be appointed to a clerical post for which he/she is educationally qualified, provided a vacancy in clerical post exists for this purpose. (ii) An application for compassionate appointment shall, however, not be rejected merely on the ground that the family of the employee has received the benefits under the various welfare schemes. While considering a request for appointment on compassionate ground a balanced and objective assessment of the financial condition of the family shall be made taking into account its assets and liabilities (including the benefits received under the various welfare schemes mentioned Page 5 of 618. 19. above) and all other relevant factors such as the presence of an earning member, size of the family etc. (iv) Compassionate appointment shall be made available to the person concerned if there is a vacancy meant for compassionate appointment and he or she is found eligible and suitable under, size the family etc. (v) Requests for compassionate appointment consequent of death or retirement on medical grounds of erstwhile sub-staff may be considered with greater sympathy by applying relaxed standards depending on the facts and circumstances of the case. (vi) Compassionate appointment shall have precedence over absorption of surplus employees and regularization of temporary employees. PAYMENT OF LUMP-SUM EX-GRATIA IN LIEU OF COMPASSIONATE APPOINTMENT:- () The cadre-wise ceiling on ex-gratia amount payable will be as follows: Category Maximum Amount Officer Rs. 8 lacs Clerical Staff Rs. 7 lacs Subordinate Staff Rs. 6 lacs (i The application for the payment of Ex-Gratia in liew of Compassionate Appointment should be submitted within Six Months from the date of Death and Board is empowered to take decision of any application submitted afterwards. However, any of these options can be used only when the other conditions of compassionate appointment are met. Page 6 of 6Aryavart Bank Head Office, A-2 /46, Vijay Khand, Gomti Nagar, Lucknow. (AN UNDERT/ )F GOVT OF INDIA, U.P. GOVT. & BANK OF INDI Proforma Regarding Employment .nts of Bank Employee Dying while in Service/Retired on Medical Grounds Part-A 1{a) Name of the Employee (Deceased/retired on medical Grounds) (b) Designati (c) Date of Birth/retirement on medical grounds (d) Date of Death/retirement on medical grounds (e) Total Length of Service rendered (f) Whether permanent or temporary (g) Whether belonging to SC/ST/OBC 2.(a) Name of the candidate for Appointment (b) His/Her relationship with the deceased/retired em) (c) Date of Birth (4) Educational Qualifications (e) Whether any other dependent family member has Been appointed on compassionate grounds 3. Particulars of total assets left including amount of (a) Family Pension (b) Gratuity (c) Provident Fund Balance () Life Insurance Pol es (Including Postal Life Ins.) (e) Moveable and immovable properties and annual income earned therefrom by the family (f) Insurance (g) Encashment of leave (h) Any other assets Total ployee4, Brief particular of liabilities, if any v, Particulars of all dependent family members of the deceased employee {if some are employed, their income and whether they are living together or separately) SiNo, Name(s) Relationship with Age Address: Employed or not (if eceased/retired ‘employed, particulars employee ‘of employment and emoluments) o @ @ 6) © 1 2 3. 4 5 vi DDECLARATION/UNDERTAKING 1. Ihereby 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. hereby also declare that | shall maintain properly the other family members who where dependent on the deceased employee mentioned against 1(a) of this form and in case itis proved at any time that the said family members are being neglected or not being properly maintained by me, my appointment may be terminated. Date: Signature ofthe candidate Shri/Sme./Kum, correct and verified by me. ate: Address: Js known to me the facts mentioned by him/her are Signature of witness* Name: Address: “Either any employee in the Senior level of Bank or Gazetted rank official from State/Central Government.PART-B (TO BE FILLED IN BY OFFICE IN WHICH EMPLOYMENT IS PROPOSED) |. (a) Name of the candidate for Appointment. (b) His/Her relationship with the deceased/retired employee (c} Age (date of birth), educational qualifications ‘And experience, if any (d) Post for which employment is proposed (e) Whether there is vacancy in that post within the ceiling of 5% prescribed under the scheme of compassionate appointment. (f) Whether the candidate fulfils the requirements of the Recruitment Rules for the post. (g) Apart from waiver of recruitment procedure What other relaxation are to be given. ll. Whether the facts mentioned in Part-A have been Verified by the office and if so, indicate the records Ill. Personal recommendation of the Competent Authority (With his signature and office stamp/seal)©) Aryavart Bank 82106, i, Gort Nagar, Lucknow. (ANLUNDERI ‘GOVT OF INDIA, U.P. GOVT. & BANK OF INDIA Enclosure to circular No, HO/PERs & LL /AKV/ 01/34 dated 01-04-2019 SCHEME FOR PAYMENT OF © 1PSUM AM LIEU oF APPou Qn ‘COMPASSIONATE GROUNDS 1. NAME: This Scheme shall be called * Bank Scheme for Payment of Ex 1m Amount in ‘of Appointment on Compassio 2. OBIECT= ‘The object of the Scheme is to enable the family of the deceased employee to tide over the sudden financial crisis arising on account of the employee's demise, by providing appropriate financial relief, in lieu of appointment, on compassionate grounds, to the dependants of these employees who die in harness or to provide financial relief to those employees who are allowed pre-mature retirement due to total incapacitation for work before reaching the age of $5 years. 3. DEFINITION :- Unless the context, otherwise requir, in the Scheme = a) ‘Bank’ means Aryavart Bank; b) ‘Board’ means Board of Directors of Aryavart Bank; ‘Employee’ means and includes only a confirmed regular employee who was serving full time for part-time on scale wages, at the time of death / premature retirement and does not include any one engaged on contract / temporary / casual / part-time on consolidated wages ‘or any person who is paid on commission basis. 4, APPLICABILITY: ‘The Scheme will be applicable in the following cases of employees (i) Employee dying in harness (other than due to injury while performing official duty); (i) Employee dying due to injury sustained while performing official duty or outside office premises (excluding travel from residence to place of work and back); (ii) Employee dying while performing official duty within or outside the office premises (excluding travel from residence to place of work and back) due to dacoity / robbery / terrorist attack. (iv) Employee seeking pre-mature retirement due to incapacitation before reaching the age of $5 years 5, PAYMENT OF EX-GRATIA AMOUNT :- Exgratia Amount willbe paid to the family of the deceased employee, it eligible, provided request to this effec, is made within 6 months from the date of death of the employee. ‘The family of the deceased employee will be eligible for Ex-gratia, subject to the celling specified in Para 7 below, if monthly income of the family from all sources, as stated in Para 6 below Is less than 60% of the last drawn gross salary (net of taxes) ofthe employee. ‘a. CALCULATION OF INCOME OF THE FAMILY OF THE DECEASED EMPLOYEE FOR CONSIDERATION OF ELIGIBILITY FOR PAYMENT OF EX-GRATIA COMPENSATION ON COMPA = () Terminal Benefits: ‘2. Provident Fund b. Gratuity Leave Encashment 4d. Any other amount paid under Banks Scheme(s) Sub-Total (A). (W)Mabitities : Loans taken from Bank and or other financi Sub-Total (8 (1) Net Corpus of Terminal Benefits (:UC Policies imran Others (V) Details of movable property, if any held and monthly income derived there from som (Vi) _ Details of immovable property, if any held and monthly income derived there from. {vll) Monthly income of the family from all sources:- (Monthly interest at the Bank's maximum Term Deposit Rate on the Net Corpus of Terminal Benefits (C).-- (i) Monthly income from investments ().. (ii) Monthly income from movable and immovable propertyn- (iv) Monthly income of dependent family members.. (spouse, unmarried son/daughter) ()—_Anyother monthly income. ‘TOTAL MONTHLY INCOME OF THE FAMILY. ‘2. AMOUNT OF EX-GRATIA: (A) Cases of Deceased Employees: If the total monthly income of the family, calculated in terms of Para (ull above, is less than 60% ofthe last drawn gross salary (net of taxes) of the deceased employee, Ex-gratia Amount wil be payable at the rate of 60% of the last drawn gross salary (net of taxes) for each month of remaining service of the deceased employee (i.e. up to the age of superannuation), subject to the following cadre-wise celing of “Maximum ‘Amout dre wise cel ia Amount, i low: ‘cateaory ‘Maximum Amount (Rs. In Lae) Officers 8.00, Clerical Staff 7.00) ‘Subordinate Staff | 6.00 In Case of death of an employee performing official duty within or outside the office premises (excluding travel from residence to place of work and back) due to dacolty / robbery / terrorist attack, the family is. also eligible to receive, additionally any other compensation avallable in terms of the extent government. {guldelines depending on the cadre of the employee. (8) Cases of ems king pre-mature ret al incapacitation for work:- in case of an employee seeking premature retirement due to total incapacitation for work, the exgratia is payable only if all extant provisions for such retirement are fully satisfied and the retirement has been ‘approved by the competent authority specified therefore. (MISCELLANEOUS. {) While dealing with proposals for grant of ex-gratia as above, in case where disciplinary action had been ‘taken/was pending against the employee dying in harness or the deceased employee was involved in financial iregularities, embezzlement of funds, committing frauds etc., banks will continue to abide by the guidelines issued by the Government of India requiring consideration and decision in each case by the Board of the bank. (i) The ex-gratia amount in eligible cases will be paid within 3 months of receipt of application, complete Inall respects. ‘The excgratia relief under the above Scheme is not an entitlement but may be granted at the sole discretion of the Bank looking into financial conditions of the family and in deserving and eligible cases only. (iv) The Board of the bank reserves its right to substitute, amend or vary from time to time any provisions of the Scheme mentioned above.Aryavart Bank 4:2 /46, Vi ‘Gomtl Nagar, (AN UNDERTAKING OF INDIA. U.P. GOVT. & BANK OF INDIA Enclosure to ciculat No, HO/PERS & LL /AKY/ O1/ 34 dated 01. PRESCRIBED APPLICATION FORM FOR PAYMENT OF EX-GRATIA LUMPSUM AMOUNT IN LIEU OF APPOINTMENTS ON COMPASSIONATE GROUNDS, TO THE DEPENDANTS OF EMPLOYEES, WHO DIED: - 1) INHARNEss ji) DUETO INJURY WHILE ON DUTY i DUE TO DACOITY/ROBBERY/TERRORIST ATTACK WHILE PERFORMING DUTIES. To, ‘The General Manager, Aryavart Bank, Head Office, Personnel ent} LUCKNOW. Dear Sir, Claim for Ex-gratia Lump sum Amount due to Death of My spouse/Father/Mother, Late Shri/smt. was working in Gramin Bank of Aryavart, Branch/Office. He/She expired on due to The deceased left behind following surviving family members Sr. Name Relation Occupation ‘Monthly income (Net) (Rs.) * Occupation - if employed, attach employer's certificate giving details like name of establishment, post occupied, place of posting, monthly income, since when employed, etc. Details of investments and properties held by my spouse/father/mother (late) Shri/Smt. are as follows :- Particulars of investments there from 1 Deposits/NSCs/PPF/LIC Policies, etc. 2. Movable Property 3. Immovable PropertyI request you to please consider my case for payment of the permissible Ex-gratia lump sum amount, as per the relevant scheme. I hereby undertake to refund Ex-gratia lump sum amount, if the information submitted by me turns out to be incorrect, even in future. Yours faithfully, Date: (Signature of the Applicant) Name Residential Address© Aryavart Bank a hand, Gomti Ni know. (AN UNDERTAKIN VT OF INDIA, U.P. GOVT. & BANK OF INL closure to circu PERS BLL /AKV/ 03 4.2019 PRESCRIBED APPLICATION FORM FOR PAYMENT OF EX-GRATIA LUMPSUM AMOUNT IN LIEU OF APPOINTMENT ON COMPASSIONATE GROUNDS, TO EMPLOYEES, WHO HAVE BEEN ALLOWED PREMATURE RETIREMENT ON MEDICAL GROUNDS DUE TO TOTAL INCAPACITATION FOR BANK'S ‘WORK. To, The General Manager, Aryavart Bank, Head Office, (Personnel Department) LUCKNOW. Dear Sir, Re: ia Lumpsum Amount due to premature retirement on medical grounds | was suffering from (Name of the disease) which rendered me permanently injcapable of performing Bank's duties. | have therefore been permitted to retire voluntarily on medical grounds from Bank's service on by the Bank's ‘Management on the recommendation of the Medical Board constituted by the Bank. I, therefore request you to allow payment of Ex-gratia Lumpsum Amount to me, in lieu of appointment on compassionate grounds to my dependants. The details of my dependant family members are as follows- Sr. | Name Relation | Occupation ‘Monthly Income (Net) (Rs.) I . Occupation - if employed, attach employer's certificate giving details like name of establishment, post occupied, place of posting, monthly income, since when employed, etc. Details of investments and properties held by me, are as follows = Monthly income derived therefrom + Particulars of investments (Deposits/NSCs/PPF/LIC Policies, etc.) * Movable Property * Immovable Property| request you to please consider my case for payment of the permissible Ex-gratia lumpsum amount, as per the relevant scheme. I hereby undertake to refund Ex-gratia lumpsum amount, if the information submitted by me turns out to be incorrect, even in future. Yours faithfully, Date (Signature of the Employee)© Aryavart Bank 82 ichand, Gomtl Nagar, Lucknow. (AN UNDERTAKING OF GOVT OF INDIA, U.P. GOVT. & BANK OF INDIA re to circular No, HO/PERs & |.L/DT-O1/ 04 dated 01-04-2019 PRESCRIBED APPLICATION FORM FOR EMPLOYEES SEEKING PREMATURE RETIREMENT ON MEDICAL GROUNDS DUE TO TOTAL INCAPACITATION FOR BANK'S WORK. To, The General Manager, Aryavart Bank, Head Office, (Personnel Department) LUCKNOW. Dear Sir, Application for premature retirement on medical grounds | am suffering from (Name of the disease) which rendered me permanently incapable of performing Bank's duties. |, therefore, request the Management to permit me to retire voluntarily on medical grounds, in terms of the Bank's Scheme for Payment of Ex: gratia Lumpsum Amount in Lieu of Appointment on Compassionate Grounds. In support of my above statement, | enclose a medical certificate issued by the Medical Board, which had been constituted by the Bank for ascertaining my fitness to perform Bank's duties. | request you to consider my case for premature retirement on medical grounds and pay me Ex- gratia lumpsum amount as permissible in terms of Branch Circular N dated for which an application Is being submitted separately. | also enclosed the following documents/certificates in support of my application (previous medical records may be enclosed). Yours faithfully, Date (Signature of the Employee)G) ‘Aryavart Bank HEAD OFFICE INTER OFFICE MEMORANDUM From: ‘The Manager To: TheGeneral Manager, Branch Head office, (Personnel Department) Lucknow Through: The Regional Manager, Region Distt Ref No, Date: ii) Staff : Officer/Office Assistant/Office Attendant Shri/smt. Date of Joining Expired/Died in Harness/Died due to Injury sustained While on duty/Died while performing official duty due to Dacolty/Robbery/Terrorist Attack on (Date) Retired on Medical Ground due to total incapacitation for work on __ (Date) Request from his/her wife/husband/son/daughter for Payment of Ex-gratia Lumpsum Amount in lieu of Appointment (Branch Circular No. BASIS OF PROPOSAL Death : (2) in Harness {b) Due to Injury sustained while on duty (c)___ While performing official duty due to Dacoity/Robbery/Terrorist Attack Retirement of medical ground due to total incapacitation for work PARTICULARS OF EMPLOYEE: Full Name Category : SC/ ST/ OBC/ GENERAL ichever is not applicable) Cadre + Officer/Office Assistant/Office Attendant) (a) Incase of Officers - Scale. P.F.No.v vi) vii wy) ” xi) w tw Date of Birth Date of Joining Date of Death Cause of Death (Death certificate to be enclosed) Period of remaining service up to the age of superannuation: Years. Months (Part of the month of the remaining service to be construed as full month) If allowed to be prematurely retired on medical ground - Give following details a) Date of premature retirement (relieving) : b) Age at the time of premature retirement: Years (must be less than 55 years for being eligible for Ex-gratia Amount) ©) _Date on which declared totally disabled by the specially constituted Medical Board {Certificate of specially constituted Medical Board to be enclosed). Date of Application for Ex-gratia lumpsum amount Date of receipt of application by the Bank (should be within 6 months of death/premature retirement) Option exercised by the employee (Pension/CPF/EPF) Details of members of family (as defined in the scheme) : Name Relation ‘Occupation Monthly Income (Net) (Rs.) Ifemployed, attach certificate of income from employer. CALCULATION OF INCOME OF THE FAMILY OF THE DECEASED/PERMANENTLY DISABLED EMPLOYEE FOR CONSIDERATION OF ELIGIBILITY FOR PAYMENT OF EX-GRATIA LUMPSUM AMOUNT Terminal Benefits Actual Amount ‘Actual Amount Settled Yet to be Settled Rs. P. Rs. PB. Provident Fund Gratuity P/LEncashment ‘Any other amount paid under Bank's Schemes - ‘Sub-Total (a) (b) Total (A) = (a) +(b)o a id a mw ™ ww) wn abilities at the time of Death/Premature Retirement Loan taken from Bank and/or other financial institutions with prior approval of the Bank Loans from Bank 1 2 ‘Amount Sanctioned ‘Amount Outstanding Staff Housing ‘Aashiyana Housing Provident Fund Loan ‘Consumer Loan Vehicle Loan Personal Loan Equity Share Loan Festival Advance NSC Loan/oD ‘TDR Loan Clean OD Others From other Financial Institutions/Banks Credit Society ii) Others Sub-Total ‘Net Corpus of Terminal Benefits (A - B) Rs. Monthly interest calculated on this amount of Net Corpus of Terminal Benefits at the Bank's maximum Term Deposit Rate o Rs. Investments : (made by the deceased prematurely retired employee) ‘Amount (Rs.) Monthly Interested (Rs.) Deposits NSCs PPF/UTI/ULIP/BONDS/SHARES LC Policies (Assured Sum/Claim Settled) Others ‘Sub-Total (D) Details of property, if any, held ‘Monthly Income derived ‘There from (Rs.) = Movable ‘= Immovable Sub-Total (E) ‘Monthly income of the dependant family members - From Gainful Employment Rs. (Net as per Salary Slip) From other Sources, if any Rs. Sub-Total (F)vm (x) NOTE: Family Pension for full month succeeding the month of death/premature Basis Rs, DA. Rs, Sub-Total (G) (if deceased employee was an ex-serviceman and opted for CPF amount of Defence Family Pension, ifany)- Rs, pam. ‘TOTAL MONTHLY INCOME OF THE FAMILY - (UC) + (0) + (EH4F+ (GI) Rs, LAST SALARY DRAWN BY THE DECEASED/DISABLED EMPLOYEE : (Salary Slip for the last month to be attached) ‘Actual salary for Full salary for the the month of death/ month preceding. Premature retirement the month of death/ Premature retirement - Gross Rs, Rs. - Actual Tax deducted/Average ‘Tax deducted every month Rs. Rs. = Gross (Net of Taxes) Rs. Rs. * (incase of loss of pay notional salary is required to be given. In case annual increment hhad accrued in the month of death/premature retirement, it must be specifically stated.) ‘THE APPLICANT WILL BE ELIGIBLE FOR PAYMENT OF EX-GRATIA LUMPSUM AMOUNT, ONLY WHEN THE TOTAL MONTHLY INCOME OF THE FAMILY CALCULATED IN TERMS OF PARA C(IX) ABOVE IS LESS THAN 60% OF THE LAST DRAWN GROSS SALARY (NET OF ‘TAXES) OF THE DECEASED/ PREMATURELY RETIRED EMPLOYEE. PARTICULARS OF APPLICANT : Full Name (Attach marriage certificate/affidavit in case of the spouse of the deceased) Present Addres Relation with deceased : Present Occupation: Monthly Income Rs.. {attach certificate from employer, if applicable)vy) Marital Status & No. of Children, if any vi) ‘As per Bank's record = Name of Nominee to (i) Provident Fund i) Gratuity Relation of nominee with the employee BRANCH RECOMMENDATION 1) We confirm that Shri/smt. W/o, S/o, D/o Late Shri is eligible to receive Ex-gratia Lump sum Amount, in terms of the Branch Circular No. dated i We confirm that Shri/Smt. who has been allowed premature retirement from the Bank on ‘on medical grounds, is eligible to received Ex-gratia Lump sum Amount, his age being less than 55 years at the time of his premature retirement. Branch Manager (Signature with Seal) RECOMMENDATION OF REGIONAL OFFIC! We certify that () The particulars incorporated by the Branch in the proposal have been verified and found correct/ incorrect/ incomplete information has been corrected/incorporated by us. ‘The necessary certificates/documentary evidence have been annexed as per check lis. ‘The application is eligible to receive Ex-gratia Lump sum Amount having regard to the following - ~ Applicant Shri/Smt. is spouse of the deceased employee. + Applicant is employee himself/herself, who has been allowed premature retirement by the Bank ‘on medical grounds. = Spouse is not living hence elder son Mr. Is eligible to receive Ex- gratia Lump sum Amount. = Inabsence of Spouse/Son of the employee, his/her eldest unmarried daughter Ms is eligible to receive ex-gratia Lump sum Amount. + There is no counter claim/dispute for Ex-gratia Lump sum Amount. REGARDING DISCIPLINARY ACTIONS (in case any disciplinary action was taken/pending/contemplated against the deceased/ prematurely retired employee, brief particulars thereof may be given, specifying the nature of the charges and the penalties imposed).“ wi COMMON DOCUMENTS TO BE SUBMITTED (CHECK UST): “ (8) © (0) () (F) (6) Hy 0 (a) (8) ie) Any other relevant information: (a) (8) © We recommend payment of Ex-gratia lump sum amount as per scheme to Mr,/Miss/Mrs. Son/Daughter/Wife of Late Shri / Smt, —_____ OR) to Shri/smt. who has been allowed premature retirement by the Bank on medical grounds. Regional Manager (Signature with Seal) Application received from Widow/Son/Daughter/Other eligible dependants for Exgratia lump sum amount, duly acknowledged by the Branch/Department with date duly recorded thereon, under the initials of an officer. Salary Slip for last month of deceased employee/t Copy of latest Provident Fund Statement. Death Certificate from the Cooperation/relevant Government Body. In case of unnatural death, copy of Police Report/FiR/Post-Mortem Report along with comments of the Area Manager. The proof for income/salary certificate etc. of the gainfully employed dependants of the deceased. Undertaking from applicant to refund Ex-gratla Lump sum Amount, if the information submitted proved to be untrue in future. 'No Objection Certificates of other dependants, if recipients is other than widow. Copy of Charge sheet/Penalty Order/Show-Cause Notice issued to the deceased/retired employee, if any. :d employee. IN CASE OF THE EMPLOYEES WHO HAVE BEEN ALLOWED PREMATURE RETIREMENT ON MEDICAL GROUNDS: (a) Certificate issued by Specially Constituted Medical Board about total disability of the employee concerned on the grounds of which he/she has been allowed to be prematurely retired from the service of the Bank. (The Bank's Medical Officer/Doctor attached to the respective Head Office/Civil Surgeon or the Medical Officer of the equivalent rank and the specialist from the respective field will be the members of the Medical Board specially constituted at Head Office only.) Details of the last medical aid claim of the employee. All columns should be completed. Allthe certificates should be verified/certfied and submitted wherever necessary. Check list, duly ticked, should also be attached with the proposal.