(1)

Ļ¯ೇಷ ªಾಜÍ ಪĦÎೆ

GOVERNMENT OF KARNATAKA

LD 274 LET 2023

Karnataka Government Secretariat,

Vikasa Soudha,

Bangalore, dated:29/06/2024

NOTIFICATION

Whereas the draft of the Karnataka Motor Transport and Other Allied Workers Social

Security and Welfare Rules, 2024 was published in Notification No. LD 274 LET 2023, dated:

16.03.2024 in part IVA No 8803 of the Karnataka Gazette dated: 19.03.2024, as required by sub-

section (1) of section 22 of the Karnataka Motor Transport and Other Allied Workers Social Security

and Welfare Act 2024 (Karnataka Act 13 of 2024) inviting objections or suggestions from all the

persons likely to be affected there by within thirty days from the date of its publication in the official

Gazette.

And whereas the said Gazette was made available to the public on 19.03.2024.

And whereas objections and suggestions received in this behalf have been considered by the

State Government.

Now, therefore, in exercise of the powers conferred by section 22 of the Karnataka Motor

Transport and Other Allied Workers Social Security and Welfare Act 2024 (Karnataka Act 13 of

2024), the Government of Karnataka hereby makes the following rules, namely:-

RULES

Title, commencement and application.- (1) These rules may be called the Karnataka

Motor Transport and Other Allied Workers Social Security and Welfare Rules, 2024.

(2) They shall come into force from the date of their publication in the Official Gazette.

(3) They shall apply to every undertaking as defined in clause (f) and (g) of sub-section (1) of

section 2 of the Act.

Definition.- (1) In these rules, unless the context otherwise requires,

(a) “Act” means the Karnataka Motor Transport and Other Allied Workers Social Security and

Welfare Act 2024 (Karnataka Act 13 of 2024);“Chairperson” means the chairperson of the

Board;

¨sÁUÀ – 4 J

Part – IVA

2024

1946)

BENGALURU, SATURDAY, 29, JUNE, 2024(ASHADHA, 08, SHAKAVARSHA, 1946)

. 313

No. 313

(b) “Member” means a member of the Board; and

(2) All other words and expressions used but not defined in these rules but defined in the Act

shall have the same meaning as assigned to them in the Act.

Functions of the Board.- The Board shall perform the following functions, namely:-

(1)

ensure registration of motor transport and other allied workers;

(2)

make recommendations to the State Government for formulation, review and

implementation of the schemes;

(3)

provide immediate assistance to a beneficiary in case of accident;

(4)

make payment towards funeral expenses due to natural death of the beneficiary;

(5)

give financial assistance for the education of children of the beneficiaries;

(6)

make payment of maternity benefit to the female beneficiary;

(7)

make payment of pension to the beneficiary who has completed the age of sixty years;

(8)

make provision for improvement of other welfare measures and facilities; and

(9)

send short message service (sms) to every beneficiary/applicant regarding status of his

application.

Term of office of Members.- (1) A member, other than an Ex-Officio member, shall

subject to the pleasure of the Government , hold office for a period not exceeding three years from

the date of his nomination or till the reconstitution of the Board whichever is earlier.

(2) A member nominated under sub clause (d) of sub-section (2) of section 3 shall cease to be

a member of the Board if he ceases to represent the category, from which he was so nominated.

(3) A member shall be eligible for re-nomination only on rotation basis.

Resignation.- (1) A member of the Board, not being a ex-officio member, may resign

his office by a letter in writing addressed to the Chairperson.

(2) The seat of such as member shall fall vacant from the date on which his resignation is

accepted or on the expiry of thirty days from the date of receipt of intimation of resignation, whichever

is earlier.

(3) The power to accept the resignation of a member shall vest in the Chairperson who, on

accepting the resignation, shall report to the Board in the next meeting.

Change of Address.- If a member changes his address, he shall notify his new address

to the Member Secretary of the Board who shall there upon enter his new address in the official

records:

Provided that if a member fails to notify his new address, the address in the official records

shall for all purpose be deemed to be the member’s correct address.

Manner of filling vacancies.- When a vacancy occurs or is likely to occur in the

Membership of the Board, the Member-Secretary shall report to the State Government and on receipt

of such report, the State Government may, by notification, nominate a person to fill the vacancy and

the person so nominated shall hold office for the remainder of the term of office of the member in

whose place he is nominated.

Allowances of members.- (1) The travelling allowance of an official member

of the Board shall be governed by the rules applicable to him for journey performed by him

on official duties and shall be paid by the authority paying his salary.

(2) The non-official members of the Board shall be entitled to the payment of

travelling and daily allowance as per the provisions of Payment of Travelling Allowance (to

Non-official Members of Committees, Commissions or other Bodies) Rules, 2001,

Annexure-A of Karnataka Civil Services Rules.

Disposal of business.- Every matter which the Board is required to take in to

consideration shall be considered at a meeting of the Board, or if the Chairperson so directs,

by circulation of resolution among the members and shall be passed by a simple majority of

votes, where there is no consensus on a matter and the members of the Board are equally

divided, the Chairperson shall have the deciding vote.

Explanation.—The expression “Chairperson” for the purpose of the above provision shall

include a member nominated or chosen under sub-rule (2) of rule 10 to preside over a

meeting.

10.

Meeting.- (1) The Board shall meet at such places and at such times as may be

decided by the Chairperson but shall meet at least once in three months.

(2) The Chairperson shall preside over every meeting of the Board in which he is

present and in his absence he may nominate a member of the Board to preside over such

meeting in his place and in the absence of such nomination by the Chairperson, the members

of the Board present in such meeting may choose one member from amongst themselves to

preside over the meeting.

11.

Notice of meetings and list of business.- (1) Ordinarily, two weeks’ notice

shall be given to the members of the Board of a proposed meeting:

Provided that the Chairperson, if he is satisfied that it is necessary so to do, may give

notice of longer period not exceeding one month for such meeting.

(2) No business except which is included in the list of business for a meeting of the

Board shall be considered at the meeting without the permission of the Chairperson.

(3) The Chairperson may at any time call a special meeting of the Board in case of

urgency, after informing the members in advance about the subject-matter of discussion and

the reason of urgency.

12.

Quorum.- (1) No business shall be transacted at any meeting of the Board unless at

least six members are present in that meeting, which shall include at least one member each from

sub-clause (i) and (ii) of clause (d) of sub-section (2) of section 3.

Provided that if at a meeting, less than six members are present, the Chairperson may adjourn

the meeting to another date informing the members present and giving notice to the other members

that he proposes to dispose off the business at the adjourned meeting whether there is quorum or not,

and it shall there upon he can transact the business at the adjourned meeting irrespective of the number

of members attending.

(2) The State Government may prohibit any member, other than ex officio members,

from taking part in the Meeting of the Board if,-

(a) The member absents himself from three consecutive meetings of the Board without

written information and consent of the Chairperson; or

(b) The member in the opinion of the State Government, has ceased to represent the

interest which he purports to represent on the Board.

13.

Collection and Assesment of cess under certain circumstances.- Levying,

assessment and collection of cess from establishments which are carrying the business of transport of

persons or goods will be done in such manner or such time and intervals through notification in the

official Gazette.

14. Registration of motor transport and other allied workers.- (1) The workers belonging

to the age group of 18 to 60 years and categories mentioned in clause (f) of section 2 of the Act shall

apply in Form I to the registering officers notified under clause (a) of section 10 of the Act, along

with his Address Proof, Aadhaar linked Bank Passbook, Driving License for drivers, Conductor

license for conductors, employee I.D Card (If available) or employment certificate in Form II issued

by the employer or if he is running own work/business submit any registration certificate issued by

the local authority to run business under e-Shram (UAN) portal along with proof of Birth.

(2) The worker applying under sub-rule (1) shall comply with the provisions of clause (f) of

sub-section (1) of section 2.

(3) The registering authority shall satisfy that the applicant has complied with the provisions

of clause (f) of sub-section (1) of section 2 and he shall collect registration fee of Rs.50/- from the

worker and register such worker as beneficiary of the schemes of the Board and shall issue him an ID

card and a receipt for the same.

(4) The registration shall be renewed for every three years with the renewal fee of Rs.50/-.

Worker shall submit updated documents regarding change of details if any in Form III.

(5) The registration of the worker shall be cancelled by the Registering Authority if such

authority is satisfied that the registration has been obtained by false statement/declaration or by

suppression of fact, after giving an opportunity of being heard to the affected worker by the registering

authority to put forth his defense in the matter, before cancellation of his registration.

(6) The Registering Authority issue to every beneficiary an identity card with photo of

beneficiary in Form IV.

15. Accident Benefit to the Registered Workers in case of Death, Disability and Medical

Reimbursement.- (1) Accident means an event which is sudden without criminal intent and

unforeseen resulting in death or incapacitation permanent, total or partial disablement;

Provided that same benefit is also available in case of cardiac arrest death (Heart attack)

occurred while on duty.

(2) "Eligibility"

Every registered worker, who meets with an accident during the course of his employment or

outside the course of his/her employment, assistance under this rule shall be given by the

Board excluding the following cases.

(a) Natural Death.

(b) Payment of compensation in respect of death or injury as a consequences of resulting

from:-

committing or attempting suicide, intentional self injury;

ii.

whilst under the influence of intoxicating liquor or drugs;

iii.

committing any breach of law with criminal intent;

16. Manner of Claims.- (1) Every registered worker or his first living nominee who is eligible

for accident benefit under sub-rule (2) of rule 14 shall apply to the Claims Authority notified under

section 13 in Form V for death and Form V(1) for medical and disability along with FIR, Post mortem

report, living member certificate of deceased and death certificate (in case of death), original medical

bills and discharge summary for medical reimbursement and medical certificate issued by the

taluk/district medical board showing clearly the percentage of permanent total disablement

(incapacitation) or permanent partial disablement suffered by the applicant due to the accident

occurred to.

(2) The Claims Authority shall examine every application for accident benefit in accordance

with the provision and may accept or reject the claim:

Provided that the claim authority in this behalf shall, before rejecting a claim for accident

benefit, give the applicant a reasonable opportunity of making the representation.

(3) The Claims Authority may grant benefit through Direct Benefit Transfer (DBT), a sum of

Rs.5.00 lakh (Rupees Five Lakh only) for first living nominee in case of death, Rs.2 lakh (Rupees

Two Lakh only) for permanent total disablement and Rs.1 lakh (Rupees One Lakh only) in case of

permanent partial disablement in proportion to the percentage of disablement or hospital expenditure

reimbursement.

17. Natural Death Assistance (Inclusive of Funeral expenses.- (1) If a registered worker dies,

the Claims Authority shall pay a sum of Rs. 25,000/- (Rupees Twenty Five Thousand only) to the

nominee of the deceased registered worker inclusive of funeral expenses of the deceased registered

worker.

(2) The application for claiming the amount specified in sub-rule (1) shall be in Form VI and

shall be accompanied by the death certificate of the deceased registered worker, Living member

certificate issued by revenue department, Aadhaar linked bank pass book and the original identity

card issued to the deceased worker or registration number of the beneficiary for verification of validity

and correctness by the Board in case of non availability of original identity card.

18. Education Assistance to registered worker’s children.- (1) The Claims Authority may,

on an application from a registered worker, sanction every year for their dependent children not

exceeding two children, annual educational assistance, as under,-

Table

SL.

No.

Educational Courses

Annual Educational

Assistance

(in Rupees)

12^th or equivalent

3000/-

Bachelor Degree or equivalent

5500/-

LLB/Para

Medical/B.Pharma/Nursing

and

other

professional courses, as specified by the State

Government

8000/-

MBBS/BE/B.Tech and Post Graduation courses

11000/-

(2) The application for claiming the amount specified in sub-rule (1) shall be in Form - VII.

(3) Educational Assistance shall be available for the current enrolment and only for the

students enrolled in regular courses in institutions recognized by the Government. Distance Education

Courses, Home Study Courses, Online Courses, etc. are not eligible to avail this benefit.

19. Education assistance to the children of the deceased/total permanent disabled

registered workers due to accident.- (1) The Claims Authority may sanction every year for

dependent children not exceeding two children of deceased worker who succumbed to accidental

death or permanent total disablement, annual educational assistance, as under,-

Table

SL.

No.

Name of Educational Courses

Annual Educational

Assistance

1^st Standard to Degree and equivalent

Rs.10,000/-

LLB/Para Medical/ B.Pharma/ Nursing and

other professional courses etc

Rs.20,000/-

MBBS/BE/B.Tech

and

Post

Graduation

courses

Rs.25,000/-

(2) The amount under sub rule (1) shall be sanctioned only if the following conditions are

fulfilled, namely:-

(a) A minimum of one year shall have lapsed from the date of registration of the applicant

to the date of his application:

(b) Only two children of a registered deceased/totally permanent disabled worker shall be

given this assistance; and

(3) The application for claiming the amount specified in sub-rule (1) shall be in Form – VIII.

(4) Educational Assistance shall be available for the current enrolment and only for the

students enrolled in regular courses in institutions recognized by the Government. Distance Education

Courses, Home Study Courses, Online Courses, etc. are not eligible to avail this benefit.

(5) Benefit provided under rule 16 shall not be applicable to these beneficiaries.

20.

Maternity benefit to registered women beneficiary.- (1) The Claims Authority, shall

on an application, sanction a sum of Rs. 10,000 (rupees five thousand only), only for first two

deliveries, to the female registered beneficiary on producing proof of delivery of a child.

(2) The amount shall be sanctioned, only if the following conditions are fulfilled, namely:

(a) A minimum of one year shall have lapsed from the date of registration of the applicant as a

worker with the Board, to the delivery of the child;

(b) A registered worker can get this assistance only twice and that second claim application shall

be accompanied by an affidavit stating that the claim is for second delivery;

(d) The registered woman worker shall not be given this assistance if she already has two living

children.

(3) The application for claiming the amount specified in sub-Rule (1), shall be in Form – IX.

21. Pension Scheme, eligibility, procedure and sanction of pension.- The conditions

regarding eligibility, procedure and sanction of pension shall be notified by the State Government.

22. Appeal.- (1) A registered worker aggrieved by an order passed by the registering officer

may appeal against such order to the Appellate Authority as notified by the Government within thirty

days of from the date of order passed.

(2) A registered worker aggrieved by the rejection of claims by the Claims Authority or any

grievance regarding claims may appeal against such order to the appellate authority as notified by

Government within sixty days from the date of rejection of such claims.

(3) the Appellate Authority, upon inquiries, dispose the said petition by passing an order of

redressed and may also issue a direction to the Registering / Claims Authority.

Provided that the Appellate Authority may admit the appeal after the expiry of the said period

of days if it is satisfied that the appellant was prevented by sufficient cause from filing the appeal in

time.

23. Time limit for submission of applications.-Time limits for submission of applications for

different claims shall be as follows:-

Sl.

No.

Rule No.

Benefits

Time Limit

Accident Benefit to the Registered

Workers in case of Death, Disability

and Medical Reimbursement.

Within One year from the

date of accident.

Natural Death Assistance (Inclusive of

Funeral expenses).

Within six months from the

date of death

Education Assistance to Registered

Workers Children.

As Notified by the Board

Education assistance to the children of

the deceased/total permanent disabled

registered workers due to accident.

As Notified by the Board

Maternity benefit to registered women

beneficiary.

Within nine months from the

date of delivery

Pension Scheme.

As notified

24. Maintenance of Audit and Accounts.- (1) The accounts of the Board shall be prepared

and maintained by the Board and shall be audited by the Auditors appointed by the Board once a year.

(2) As soon as may be after the receipt of the report of the auditor, the Board shall send a copy

of the annual statement of accounts, together with the copy of the report of auditor to the State

Government.

(3) The State Government may, after perusal of the report of the auditor, give such directions,

as it thinks fit, to the Board and the Board shall comply with such directions.

25. Annual Reports.- The Board shall submit to the Karnataka State Legislature as soon as

may be after the 1st of April every year and not later than 31st day of December an Annual Report in

Form X, a soft and hard copies as may be required on the working of the Board during preceding year

ending on 31st march of the year along with audited copies of Accounts together with an auditor’s

report.

26. Books of accounts, register and other records.- (1) The Board shall maintain cash

(2) The Board shall maintain required books of accounts for the purpose specified in rules 22

and 23.

(3) The Board shall maintain all the database of registration and claims in electronic format

securely.

(4) The Board may maintain such records and registers as it consider necessary.

(5) The Registering Authority and Claims Authority shall maintain all the records submitted

by applicant/beneficiary and produce those records whenever required by higher authority.

FORM – I

[See sub-rule (1) of rule 14]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Application for registration with “Karnataka Motor Transport and Other Allied Workers Social

Security and Welfare Board.

To,

Registering Officer

Name as Per Aadhaar:

Father/Spouse Name:

Permanent Address:

__________________Taluk_____________District

____________State___________ PIN___________

03(A)

Assembly Constituency

Present Address

__________________Taluk_____________District

____________State___________ PIN___________

UAN No. (eShram registration

No.)

05(A)

Aadhaar No.

05(B)

Ration Card Type and No.

APL/BPL and No.

Gender

Male/Female/Transgender

Date of Birth

DD/MM/YYY

Religion

Hindu/Muslim/Christian/Other

08(A)

Caste

SC/ST/OBC/Gen

Educational Qualification

Illiterate / PrimarySchool / Secondary School / 10^th /

12^th / ITI / Diploma / Degree / Post Graduate

Nature of Work

As per List identified by the Board.

Experience in Work at the time

of registration

Year and Month

Work Specified registration No.

(i.e., If driver DL No., If

conductor License No. etc.)

Working with

Employer/Organisation

Yes/No

14(A)

If Yes

a) Name of the Employer

b)Address with contact No.

c)Daily Wage.

d)Monthly Wage.

Nominee Details

Sl.No:

Name:

Gender:

Relation: Father/Mother/Spouse/Son/Daughter.

Age:

Marital Status:

Aadhaar Linked Bank Account

No.

I hereby declare that all the above information and documents submitted are true and collect to the

best of my knowledge and belief. I also realise that it is an offence to furnish false information to a

public authority and that if any information is found false, I may be prosecuted for the same.

Place:

Date:

Signature/LTI

Applicant

Documents to be upload:

 Photo

 Employee ID/Employment Certificate (If working in an organisation).

Acknowledgment

Smt./Mr.……………………………

Application

No.

……………………………

Date:…………………… an application has been submitted for registration with “Karnataka

Motor Transport and Other Allied Workers Social Security and Welfare Board. The application

and supporting documents are subject to verification.

Place :

Date : Signature and seal of the officer

Sanction/Rejection Order

Application No.………………Date……………… registration with “Karnataka Motor Transport and Other

d Workers Social Security and Welfare Board and documents are satisfactory. So, I registered the worker

“Karnataka Motor Transport and Other Allied Workers Social Security and Welfare Board.

Place :

Date : Signature of the registration authority

…………………………………………………………………………………………………………………

……………………………………………………………………………………………………………

For

the

following

reasons I

have rejected the

application

No.:………………………………

Date:………………………… for registration with “Karnataka Motor Transport and Other Allied Workers

Social Security and Welfare Board.

Place :

Date : Signature of the registration authority

FORM –II

[See sub-rule (1) of rule 14]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Employment Certificate

Shri/Smt./Kum__________________________C/o___________________

residing

_________________________________________________,

working

_____________________________ in our organisation since___________ months __________years. He/She

is receiving Rs._________as daily/monthly wages.

Our Organisation details are as follows:

1. Name of Organisation/Employer:__________________________________

2. Address

Organisation/Employer:

________________________

_____________________________________________________________

3. Name and Phone/Mobile No of Contact person:______________________

4. Employee ID (If available) and Date of Joining our organisation:____________________________

Place:

Date:

Signature and seal of employer/organisation

FORM –III

[See sub-rule (4) of rule 14]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Application for renewal of registration with “Karnataka Motor Transport and Other Allied Workers

Social Security and Welfare Board.

To,

Registering Officer

Tick Which is to be updated in registration details

Registration No.

and Date of

registration

registering

officer details

Name as Per

Aadhaar:

Father/Spouse

Name:

Permanent

Address:

__________________Taluk_____________District________

____State___________ PIN___________

Assembly

Constituency

Present Address

__________________Taluk_____________District________

____State___________ PIN___________

UAN No.

(eShram

registration No.)

Can not

change

Aadhaar No.

Can not

change

Ration Card

Type and No.

APL/BPL and No.

Gender

Can not

change

Male/Female/Transgender

Date of Birth

Can not

change

DD/MM/YYY

Religion

Can not

change

Hindu/Muslim/Christian/Other

Caste

Can not

change

SC/ST/OBC/Gen

Educational

Qualification

Illiterate / Primary School / Secondary School / 10^th / 12^th / ITI

/ Diploma / Degree / Post Graduate

Nature of Work

As per List identified by the Board.

Experience in

Work at the time

of registration

Year and Month

Work Specified

registration No.

(i.e., If driver

DL No., If

conductor

License No.

etc.)

Can not

change

d unless

occupat

ion

change

Working with

Employer/Organ

isation

Yes/No

If Yes

a) Name of the Employer

b)Address with contact No.

c)Daily Wage.

d)Monthly Wage.

Nominee Details

Sl.No:

Name:

Gender:

Relation: Father/Mother/Spouse/Son/Daughter.

Age:

Marital Status:

Aadhaar Linked

Bank Account

No.

I hereby declare that all the above information and documents submitted are true and collect to the best of

my knowledge and belief. I also realise that it is an offence to furnish false information to a public authority

and that if any information is found false, I may be prosecuted for the same.

Place:

Date:

Signature/LTI of Applicant

Documents to be upload:

 Photo

 Employee ID/Employment Certificate (If working in an organisation).

Acknowledgment

Smt./Mr.……………………………

Application

No.

……………………………

Date:…………………… an application has been submitted for renewal of registration with

“Karnataka Motor Transport and Other Allied Workers Social Security and Welfare Board. The

application and supporting documents are subject to verification.

Place :

Date : Signature and seal of the officer

Sanction/Rejection Order

Application No.………………Date……………… renewal of registration with “Karnataka Motor

sport and Other Allied Workers Social Security and Welfare Board and documents are satisfactory.

registered the worker with “Karnataka Motor Transport and Other Allied Workers Social Security

Welfare Board.

Place :

Date : Signature of the registration authority

………………………………………………………………………………………………………………

…………………………………………………………………………………………………For

the

following

reasons

have

rejected

the

application

No.:………………………………

Date:………………………… for renewal of registration with “Karnataka Motor Transport and Other

Allied Workers Social Security and Welfare Board.

Place :

Date : Signature of the registration authority

FORM –IV

[See sub-rule (6) of rule 14]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Identity Card

Govt. of Karnataka

: Department of Labour

Karnataka Motor and Other Allied Workers Social Security and Welfare Board, Bengaluru

Identity card

Registration No.

with date of

registration and

expiry

Name

Father/Spouse

Name

Gender

Date of Birth

Occupation

Address

Mobile No.

/LTI

Photo

Terms and Conditions

Contact Details

FORM –V

[See sub-rule (1) of rule 16]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Application for Accidental Death Claim to Registered Workers

Application No:

To,

Claim Authority,

Applicant's/Nominee Personal Details:

Name as per Aadhar

Date Of Birth & Age

Aadhar Number

Relationship with Registered Worker

Address

Permanent

Present

Mobile Number

Date of accident.

Date of Death

Registration Details of Transport Workers:

Transport Worker Name

Registration Number:

Driving/Conductor License Number

(In Case Drivers/Conductor)

Father/Spouse Name

Date Of Birth & Age:

Occupation:

Bank Details of Applicant/Nominee

Bank Name

Branch Name

Aadhaar linked Account Number

IFSC Code

List of Documents Submitted: (All Attested copy’s) Yes/No

Original registration Identity Card of worker

Valid Driving/Conductor license Copy (In case of

Drivers/Conductor)

Applicant/

Nominee

Photo

Registered

Workers

Photo (if

available)

FIR copy (Attested by respected Police Station).

Post Mortem report (Attested by respected Police

station or Hospital)

Death Certificate of worker

Aadhar card copy of Applicant/Nominee and deceased

Ration card (If available)

Living Member Certificate of deceased (Issued by

Revenue Department)

Copy of Applicant/Nominee Aadhaar linked bank

passbook

I hereby declared that the details furnished above are true and correct to the best of my knowledge.

In case any of above information is found to be false or untrue. I am aware that I may be held liable for it.

Place :

Date : Signature/Thumb impression of the Nominee

Acknowledgment

Smt./Mr.……………………………

Application

No.

……………………………

Date:…………………… an application has been submitted for accidental benefit. The

application for accidental death benefit and supporting documents are subject to verification.

Place :

Date : Signature and seal of the officer

Sanction/Rejection Order

Application No.………………Date……………… for accidental death benefit and documents are satisfactory. So, I paid

……………………………… under accidental death benefit for the ……………….. year.

Place :

Date : Signature of the Claim authority

…………………………………………………………………………………………………………………………

……………………………………………………………………………………………………

For

the

following

reasons

have

rejected

the

application

No.:………………………………

Date:………………………… for accidental death benefit.

Place :

Date : Signature of the claim authority

FORM –V(1)

[See sub-rule (1) of rule 16]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Application for Accidental Permanent Disability /Medical Reimbursement to Registered Workers

Application No:

To,

Claim Authority,

Applicant/Registered worker Personal Details:

9. Name as per Aaadhaar

10. Registration Number:

11. Occupation:

12. Driving License Number (In

Case Drivers/Conductor)

13. Date Of Birth & Age

14. Aadhar Number

15. Address

Permanent

Present

16. Mobile Number

17. Date of accident.

18. Claim type

Medical

Permanent

Disability

19. If disability, Disability certificate

No. issued by medical board.

20. Percentage of Disability.

Bank Details of Applicant/Registered worker

 Bank Name

 Branch Name

 Aadhar linked ban account

Number

 IFSC Code

List of Documents Submitted: (All Attested copy’s) Yes/No

1. Registration Identity Card

2. Valid Driving/Conductor license Copy (In case of

Drivers/Conductor)

3. FIR copy (Attested by respected Police Station).

4. Disability certificate issued by medical board

Registered

Workers

Photo

5. Original Bills and Cash Paid Receipts of Hospital

(Original copy).

6. Discharge Summary (Original copy).

7. X-Ray Copies (Original copy).

8. Aaadhar card copy of applicant/registered worker

9. Copy of Applicant/registered workers Bank

Passbook

I hereby declared that the details furnished above are true and correct to the best of my knowledge.

In case any of above information is found to be false or untrue. I am aware that I may be held liable for it.

Place :

Date :

Signature/Thumb impression

of the Applicant/registered worker

Acknowledgment

Smt./Mr.……………………………

Application

No.

……………………………

Date:…………………… an application has been submitted for accidental permanent

disability /medical reimbursement benefit. The and supporting documents are subject to

verification.

Place :

Date : Signature and seal of the office

Sanction/Rejection Order

Application No.………………Date……………… for accidental permanent disability /medical

bursement benefit and documents are satisfactory. So, I paid Rs. ………………………………

er accidental permanent disability /medical reimbursement benefit for the ……………….. year.

Place :

Date : Signature of the Claim authority

………………………………………………………………………………………………………………

For the following reasons I have rejected the application No.:………………………………

Date:………………………… for accidental permanent disability /medical reimbursement benefit.

Place :

Date : Signature of the claim authority

FORM –VI

[See sub-rule (2) of rule 17]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Application for Natural Death Claim to Registered Workers

Application No:

To,

claim authority.

Applicant/Nominee Personal Details:

21. Name as per Aadhar

22. Date Of Birth & Age

23. Aadhaar Number

24. Relationship with Registered

Worker

25. Address

Permanent

Present

26. Mobile Number

Registration Details of Transport Workers:

7. Transport Worker Name

8. Registration Number:

9. Driving /Conductor License

Number (In Case

Drivers/Conductor)

10. Father/Spouse Name

11. Date Of Birth & Age:

12. Occupation:

13. Date of Death:

Bank Details of Nominee

 Bank Name

 Branch Name

 Aadhaar linked bank account

number

 IFSC Code

List of Documents Submitted: (All Attested copy’s) Yes/No

10. Original registration Identity Card of worker

Applicant/

Nominee

Photo

Registered

Workers

Photo (If

available)

11. Death Certificate of worker

12. Aadhaar card copy of Applicant/Nominee and

deceased

13. Valid Driving/Conductor license Copy (In case of

Drivers/Conductor)

14. Living member certificate issued by revenue

department.

15. Ration card (if available)

16. Copy of Applicant/Nominee Aadhaar linked Bank

Passbook

I hereby declared that the details furnished above are true and correct to the best of my knowledge.

In case any of above information is found to be false or untrue. I am aware that I may be held liable for it.

Place :

Date : Signature/Thumb impression of the Nominee

Acknowledgment

Smt./Mr.……………………………

Application

No.

……………………………

Date:…………………… an application has been submitted for natural death benefit. The

application and supporting documents are subject to verification.

Place :

Date : Signature and seal of the officer

Sanction/Rejection Order

Application No.………………Date……………… for natural death benefit and documents are

factory. So, I paid Rs. ……………………………… under natural death benefit for the

………….. year.

Place :

Date : Signature of the Claims Authority

………………………………………………………………………………………………………………

For the following reasons I have rejected the application No.:………………………………

Date:………………………… for natural death benefit.

Place :

Date : Signature of the Claims Authority

FORM –VII

[See sub-rule (2) of rule 18]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Education Assistance For Registered Transport Workers Children

Application No:

To,

Claim Authority,

Transport Worker's Personal Details:

1. Name as per Aadhaar

2. Registration Number:

3. Date Of Birth & Age

4. Aadhar Number

5. Occupation

6. Postal Address

7. Mobile Number

Education Details of Beneficiary Children:

Sl.

Student Name

Date

Birth

The

class

being

studied

Aaadhaar

Number

School Name, Address

& Contact Number

Bank Details of Student

 Bank Name:

 Branch Name:

 Account Number:

 IFSC Code:

List of Documents Submitted:

1. Registration card

2. Current Year Study Certificate

3. Previous Year Passed Marks Card

Student

Photos

4. Aadhaar card copy of Applicant & Student

5. Copy of student aadhaar linker bank Passbook

I hereby confirm that the information given above is correct to the best of my knowledge and belief and

that not more than two children have received similar facility.

Place :

Date : Signature/Thumb impression of the Applicant

Acknowledgment

Smt./Mr.……………………………

Application

No.

……………………………

Date:…………………… An application has been submitted for Educational Financial

Assistance. The application and supporting documents including signatures are subject to

verification.

Place :

Date : Signature and seal of the office

Sanction/Rejection Order

Application No.………………Date……………… for Educational Financial Assistance and

uments are satisfactory. So, I paid Rs. ……………………………… under Educational Financial

stance Facility in the ……………….. year ……………………… to the student of ………………..

Place :

Date : Signature of the claim authority

………………………………………………………………………………………………………………

For the following reasons I have rejected the application No.:………………………………

Date:………………………… for Educational Financial Assistance Facility.

Place :

Date : Signature of the claim authority

FORM –VIII

[See sub-rule (3) of rule 19]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Education Assistance For Deceased/Permanent Disabled Registered Workers due to accident

Application No:

To,

Claim Authority.

Registered worker personal Details:

27. Name as per Aadhaar

28. Registration Number:

29. Order No. benefits claimed under

Rule ().

30. Date Of Birth & Age

31. Aadhaar Number

32. Relationship with Registered Worker

33. Postal Address

34. Mobile Number

Details of registered worker Children’s:

Sl.

Student Name

Date

Birth

The

class

being

studied

Aadhaar

Number

School Name, Address

& Contact Number

Bank Details of Students

 Student Name as per bank

passbook.

 Bank Name

 Branch Name

 Account Number

 IFSC Code

List of Documents Submitted:

Student

Photo

17. Identity Card

18. Current Year Study Certificate

19. Previous Year Passed Marks Card

20. Order Copy of benefits claimed under Rule ()

21. Aadhaar card copy of registered worker & Student

22. Copy of student aadhaar linked bank passbook

I hereby confirm that the information given above is correct to the best of my knowledge and belief and

that not more than two children have received similar facility.

Place :

Date :

Signature/Thumb impression of the Applicant/

registered worker/student

Acknowledgment

Smt./Mr.…………………………… Application No. …………………………… Date:…………………… An

application has been submitted for educational assistance for deceased/permanent disabled registered workers

due to accident. The application and supporting documents including signatures are subject to verification.

Place :

Date : Signature and seal of the office

Sanction/Rejection Order

Application No.………………Date……………… for educational assistance for deceased/permanent

bled registered workers due to accident and documents are satisfactory. So, I paid Rs.

………………………… under educational assistance for deceased/permanent disabled registered workers

o accident in the ……………….. year.

Place :

Date : Signature of the Claims Authority

For the following reasons I have rejected the application No.:………………………………

Date:………………………… for educational assistance for deceased/permanent disabled registered

workers due to accident.

Place :

Date : Signature of the Claims Authority

FORM –IX

[See sub-rule (3) of rule 20]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Maternity Benefit for Registered Female Transport Worker

Application No:

To,

Claims Authority,

Transport Worker's Personal Details:

8. Name as per Aadhar

9. Registration Number:

10. Date Of Birth & Age

11. Aadhar Number

12. Occupation

13. Address

Permanent Present

14. Mobile Number

Maternity Details of Transport Workers:

1. Date of Delivery

2. Gender of Child

3. Place of birth

4. Whether claiming for

First/Second child

Bank Details of registered worker

 Bank Name:

 Branch Name:

 Account Number:

 IFSC Code:

List of Documents Submitted:

6. Registration Card

7. Tayi card

8. Birth Certificate of Chaild

9. Copy of aadhaar linked bank Passbook

Worker

Photo

10. Affidavit stating previously not claimed for any

children/claiming for second children

I hereby confirm that the information given above is correct to the best of my knowledge and belief and I

have not more than two children have received similar facility.

Place :

Date :

Signature/Thumb impression of the registered worker

Acknowledgment

Smt./Mr.……………………………

Application

No.

……………………………

Date:…………………… an application has been submitted for maternity benefit. The

application and supporting documents are subject to verification.

Place :

Date : Signature and seal of the office

Sanction/Rejection Order

Application No.………………Date……………… for maternity benefit and documents are

factory. So, I paid Rs. ……………………………… under maternity benefit for the ………………..

Place :

Date : Signature of the Claims Authority

………………………………………………………………………………………………………………

For the following reasons I have rejected the application No.:………………………………

Date:………………………… for maternity benefit.

Place :

Date : Signature of the Claims Authority

FORM –X

[See rule 25]

THE KARNATAKA MOTOR TRANSPORT AND OTHER ALLIED WORKERS SOCIAL

SECURITY AND WELFARE BOARD

Annual Report for the Year ___________.

Sl.No.

Particular

Information

Name of the Board

Date of Constitution

Name of Chairperson

Members of the Board

Regional Office (If any)

No. of Staff of the Board with grade wise (Including

regional office)

No. of beneficiaries registered with the Board.

No. of beneficiaries registered during the Year.

State the number of meetings held with dates during

the year and copy of proceedings to be attached.

Audit identifications during the year.

Compliance

taken

for

year

audit

identifications

Internal audit report to be attached along with

financial statements

Recommendations

Internal

auditor

during

previous year and compliances.

Cash and Bank balance at the end of 31^st March. (If

more than one bank account, mention separately).

Movable and immovable property details.

Receipts during the year as per section 14 of the act.

Expenditure as per section 15 of the act. (mention

Scheme wise and other expenditure details).

Court Case details if any.

Proposals sent during the year to Govt.

By Order and in the name of the

Governor of Karnataka,

Suma S.

Under Secretary to Government,

Labour Department.

ಮುದÎಕರು ²ಾಗೂ ಪÎಾಶಕರು:- ಸಂಕಲ£ಾĩಾĸಗಳ…, ಕ£ಾಟಕ ªಾಜÍಪತÎ, ಸಾĸ ೇಂದÎ ಮುದÎžಾಲಯ, ¦ೆಂಗಳˆರು

R.N.I. No. KARBIL/2001/47147 POSTAL REGN. No. RNP/KA/BGS/2202/2017-19

Licensed to post without prepayment WPP No. 297

THAMMAIAH

Digitally signed by THAMMAIAH

DN: c=IN, st=Karnataka, 2.5.4.20=be54f34f4e31eae50203ca7fab5ceb3794f20a8460a2582ef28294d43b8f8b16, postalCode=560059, street=BANGALORE,

pseudonym=ca58c76cf7e2445d7a4f3f51407e025e, serialNumber=4d9b284dcc53d39f1425f50485de07dd86efa302a3fce3729eddea0c1b5098e0, ou=GOVERNMENT OF

KARNATAKA, o=GOVERNMENT OF KARNATAKA, cn=THAMMAIAH

Date: 2024.06.29 17:28:32 +05'30'