(1)
Ļ¯ೇಷ ªಾಜÍ ಪĦÎೆ
GOVERNMENT OF KARNATAKA
NO: LD 386 LET 2023
Karnataka Government Secretariat,
Vikasa Soudha,
Dr. B.R. Ambedkar Veedhi
Bangalore, dated:24/09/2025
NOTIFICATION
The draft of the Karnataka Cine and Cultural Activists Social Security and
Welfare Rules, 2025 which the Government of Karnataka proposes to make in
exercise of the powers conferred by section 21 of the Karnataka Cine and Cultural
Activists (Welfare) Act, 2024 (Karnataka Act 46 of 2024) is hereby published as
required by sub-section (1) of the said section for the information of all the persons
likely to be affected thereby and notice is hereby given that the said draft will be
taken into consideration after the expiry of thirty days from the date of its
publication in the Official Gazette.
Any objection or suggestion which may be received by the State Government
from any person with respect to the said draft before the expiry of the period
specified above will be considered by the State Government. Objections and
suggestions may be addressed to the Secretary to Government, Labour
Department, Vikasa Soudha, Dr B.R. Ambedkar Veedhi, Bengaluru-560001.
DRAFT RULES
1. Title, commencement and application.- (1) These rules may be called
the Karnataka Cine And Cultural Activists (Welfare) Rules, 2025.
(2) They shall come into force from the date of their final publication in the
Official Gazette.
(3) They shall apply to every undertaking as defined in clause (o) of section 2
of the Act.
2. Definition.- (1)In these rules, unless the context otherwise requires
(a) “Act” means the Karnataka Cine And Cultural Activists (Welfare) Act,
2024 (Karnataka Act 46 of 2024);
¨sÁUÀ – 4J
Part – IVA
24
2025
02
1947)
BENGALURU, WEDNESDAY, 24 SEPTEMBER, 2025 AASHWAYUJA 02, SHAKAVARSHA 1947)
. 627
No. 627
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(b) “Accident” means an event which is occurred suddenly without criminal
intention and unforeseen act resulting in death or incapacitation leading
to permanent or total or partial disablement;
(c) “Employer” means the person who employs directly or indirectly the
Cine and Cultural Activist;
(d) “Chairperson” means the Chairperson of the Board;
(e) “Member” means a member of the Board; and
(f)
“Section” means a section of the Act.
(2) All other words and expressions used but not defined shall have the same
meaning as assigned to them in the Act.
3. Allowances of members:- (1) The travelling allowance of an official
member of the Karnataka Cine And Cultural Activists’ Welfare 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.
4. 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) 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.
(3) 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.
(4) 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.
5. Quorum:- (1) No business shall be transacted at any meeting of the
Board unless fifty percent of the Board members are present in that meeting:
Provided that, if at a meeting, less than fifty percent of 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.
3
(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.
6. Appointment of Registering Officers:- The Government may, by
order notify in the official gazette,-
(a) such persons, being officers of the Government not below the
rank of labour inspectors in the Labour Department as it
thinks fit, to be the Registering Officers to register cine and
cultural activists for the purposes of this Act;
(b) define the limits within which a registering officer shall
exercise the powers conferred on him by the Act or under this
Rules.
(c) a digital portal shall be in place to carry out the registration
process along with integration of digital data from such
similar portals.
7. Registration of Cine and Cultural Activists.- (1) The Cine and
Cultural Activists belonging to the age group of 18 to 60 years and
categories mentioned in clause(e) of section 2 of the Act shall apply in Form
I to the registering officers notified under clause (a) of rule 6 of along with
his Address Proof, Aadhaar linked Bank Passbook or E-shram (UAN),
employee I.D Card (If available) or employment certificate in Form II issued
by the employer:
Provided that, the Cine and Cultural Activist applying shall perform
Cine and Cultural activity.
(2) The Registering Authority after satisfying that the applicant has
complied with the provisions of clauses (e)&(f) of section 2 of the Act and
register such Cine and Cultural activists as beneficiary of the schemes of
the Board and shall issue him an unique ID card and a receipt for the same.
The ID card is valid for a period of three years.
(3) The registration shall be renewed for every three years. Cine and
Cultural activists shall submit updated document regarding change of
details if any in Form III.
(4) The registration of the Cine and Cultural activists shall be cancelled
by the Registering Authority if such authority is satisfied that the
registration has been obtained by false statement or declaration or by
suppression of fact by fraud, after giving an opportunity of being heard to
the affected Cine and Cultural activists by the Registering Authority to put
4
forth his defense in the matter, before cancellation of his registration.
(5) The Registering Authority issues to every beneficiary an unique
identity card with photo of beneficiary in Form IV.
8. Collection and Assessment of cess.- (1) Two percent cess on
Cinema Tickets of all theatres including Multiplex Theatres.
(2) Two percent cess on total transaction of Television entertainment
channels operating in the State of Karnataka.
(3) Levying, assessment and collection of cess from establishments
notified by the Government from time to time will be done in such manner
or such time and such intervals as notified by the Government in the official
Gazette.
(4) The cess shall be collected by the Government and transferred to
the Board quarterly.
9. Grants in Aid from the Government.- Government grants to be
allocated for cultural activists other than cinema and Television channels
activists.
10. Appointment of Collection Officer.- The Government may, by
notification in the official gazette,-
(a) appoint such persons, being officers of the Government not below
the rank of labour officers in the Labour Department as it thinks
fit, to be the Collecting Officers to collect the cess for the purposes
of the Act and these rules;
(b) specify the limits within which a Collection Officer shall exercise
the powers conferred on him by or under the Act and these rules;
(c) a digital portal shall be in place to carry out the collection process
along with integration of digital data from such similar portals.
11. Claims Authority.- The Government may, by notification in the
official gazette, appoint such officers of the State Government not below
the rank of Labour Officers in the Labour Department as it thinks fit, to be
the Claims Authority.
12. Accident Benefit to the Registered Cine and Cultural Activists in
case of Death, Disability and Medical Reimbursement.- (1) the registered Cine
and Cultural activists shall be eligible for accident benefit in case of death,
disability and medical reimbursement:
Provided that, the same benefit shall also available in case of cardiac arrest
death (Heart attack) occurred while on duty.
(2) Every registered Cine and Cultural activists, who meets with an
accident during the course of his employment or outside the course of his/her
employment, shall be eligible for all accident benefits given by the Board under
these rules:
5
Provided that, a registered Cine and Cultural activists shall not be eligible
for accident benefits under these rules in following circumstances,-
(a) Natural Death.
(b) Payment of compensation in respect of death or injury as a consequences
of resulting from:-
(i) committing or attempting to commit suicide, intentional self
injury;
(ii) whilst under the influence of intoxicating liquor or drugs;
(iii) committing any breach of law with criminal intent;
(3) Procedure for Claims shall be as follows, namely:-
(a) Every registered Cine and Cultural activists or his first living nominee who
is eligible for accident benefit under sub-rule (2) shall apply to the Claims
Authority notified under rule 13 for death in Form V and for accidental
permanent disability or medical reimbursement in form VI 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 or
district medical Board showing clearly the percentage of permanent total
disablement (incapacitation) or permanent partial disablement suffered by
the applicant due to the accident.
(b) The Claims Authority shall examine every application for accident benefit
in accordance with the provisions of the act and these rules 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.
(c) The amount of compensation in case of death, permanent total disablement
and permanent partial disablement in proportion to the percentage of
disablement or hospital expenditure reimbursement shall be as specified by
the Government by notification.
13. Natural Death Assistance (Inclusive of Funeral expenses).- (1) If a
registered Cine and Cultural activists dies naturally, the Claims Authority shall
pay such amount as notified by the Government by notification from time to time
to the nominee of the deceased registered Cine and Cultural activists inclusive of
funeral expenses of the deceased registered Cine and Cultural activists.
(2) The application for claiming the amount specified in sub-rule (1) shall be
in Form VII and shall be accompanied by the death certificate of the deceased
registered Cine and Cultural activists Living member certificate issued by revenue
department, Aadhaar linked bank pass book and the original identity card issued
to the deceased Cine and Cultural activists or registration number of the
beneficiary for verification of validity and correctness by the Board in case of non
availability of original identity card.
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14. Education Assistance to Children’s of registered Cine and Cultural
Activists.- (1) The Claims Authority may, on an applications made by a registered
Cine and Cultural activists in form-VIII, sanction every year for their dependent
children not exceeding two children, annual educational assistance for the courses
specified in the table.
Table
SL.
No.
Educational Courses
01
12th or equivalent
02
Bachelor Degree or equivalent
03
LLB/Para Medical/B.Pharma/Nursing and other
professional courses, as specified by the State
Government
04
MBBS/BE/B.Tech and Post Graduation courses
(2) The Claims Authority shall pay such amount as notified by the
Government by notification.
(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:
Provided that, Educational Assistance benefit shall not be available for
Distance Education Courses, Home Study Courses, Online Courses, etc.
15. Education assistance to the children of the deceased/total
permanent disabled registered Cine and Cultural Activist’s due to accident.-
(1) The Claims Authority may every year sanction annual educational assistance
for dependent children, not exceeding two children of the deceased Cine and
Cultural activists who succumbed to accidental death or permanent total
disablement for the courses specified in the table.
Table
SL.
No.
Name of Educational Courses
01
1st Standard to Degree and equivalent
02
LLB/Para
Medical/
B.Pharma/
Nursing
and
other
professional
courses etc.,
03
MBBS/BE/B.Tech
and
Post
Graduation courses
(2)
The Claims Authority shall pay such amount as notified by the by the
Government by notification from time to time.
(3) The amount under sub rule (1) shall be sanctioned only if the following
conditions are fulfilled, namely:-
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(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 or totally permanent disabled
Cine and Cultural activists.
(4) The application for claiming the amount specified in sub-rule (1) shall be
in Form – IX.
(5) Educational Assistance shall be available for the current enrolment and
only for the students enrolled in regular courses in institutions recognized by the
Government:
Provided that, educational assistances shall not be available for Distance
Education Courses, Home Study Courses, Online Courses, etc.
(6) Benefit provided under rule 14 shall not be applicable to these
beneficiaries.
16. Maternity benefit to registered woman Cine and Cultural activists:-
(1) The Claims Authority on an application in form-X shall sanction such amount
as notified by the Government by notification, only for first two deliveries, to the
female registered Cine and Cultural activists 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 Cine and Cultural activists with the Board, to
the delivery of the child;
(b) A registered woman Cine and Cultural activists 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;
(c) The registered woman Cine and Cultural activists shall have no dues
payable to the Board; and
(d) The registered woman Cine and Cultural activists shall not be given
this assistance if she already has two living children.
17. Pension Scheme, eligibility, procedure and sanction of pension.-
The conditions regarding eligibility, procedure and sanction of pension as may be
specified by the State Government.
18. Time limit for submission of applications.- Time limits for
submission of applications for different claims shall be as follows, namely:-
Sl.
No.
Rule
No.
Benefits
Time Limit
01
12
Accident Benefit to the
Registered
Cine
and
Cultural Activists in case of
Death,
Disability
and
Medical Reimbursement.
Within One year from the
date of accident.
8
02
13
Natural Death Assistance
(Inclusive
of
Funeral
expenses).
Within six months from the
date of death.
03
14
Education Assistance to
Registered
Cine
and
Cultural
Activists
Children.
Within 6 months from the
date of admission.
04
15
Education
assistance
to
the
children
of
the
deceased/total permanent
disabled registered Cine
and Cultural Activists
due to accident.
Within 6 months from the
date of admission.
05
16
Maternity
benefit
to
registered
woman
beneficiary.
Within nine months from the
date of delivery
06
17
Pension Scheme.
As notified
19. Appeal.- (1) A registered Cine and Cultural activists aggrieved by an
order passed by the Registering Officer may appeal against such order to the
Appellate Authority not below the rank of Assistant Labour Commissioners as
notified by the Government within thirty days of from the date of order passed.
(2) A registered Cine and Cultural activists 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 or
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.
(4) The Appellate Authority shall dispose of the appeal with in the period of
ninety days from the date of receiving the appeal.
20. 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.
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21. 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 XI, 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.
22. Books of accounts, register and other records:- (1) The Board shall
maintain cash register, assets register and all the books of accounts.
(2) The Board shall maintain required books of accounts for the purpose
specified in rules 20 and 21.
(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 considers
necessary.
(5) The Registering Authority and Claims Authority shall maintain all the
records submitted by applicant or Cine and Cultural activists and produce those
records whenever required by higher authority.
******
FORM –I
[See sub-rule (1) ofrule7]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Application for registration with “Karnataka Cine and Cultural Activists Welfare
Board.
To,
Registering Officer
01
Name as Per Aadhaar:
02
Father/Spouse Name:
03
Permanent Address:
__________________Taluk_____________
District____________State___________
PIN___________
03(A)
Assembly Constituency
04
Present Address
__________________Taluk_____________Distri
ct____________State___________
PIN___________
05
UAN No. (e-Shram
registration No.)
05(A)
Aadhaar No.
05(B)
Ration Card Type and No.
APL/BPL and No.
06
Gender
Male/Female/Transgender
10
07
Date of Birth
DD/MM/YYY
08
Religion
Hindu/Muslim/Christian/Other
08(A)
Caste
SC/ST/OBC/Gen
10
Educational Qualification
Illiterate/Primary
School/Secondary
School/10th/12th/ITI/Diploma/Degree/P
ost Graduate
11
Nature of Work
As per List identified by the Board.
12
Experience in Work at the
time of registration
Year and Month
13
Working with The Cine
and
Cultural
Activist/
Organization
Yes/No
13(A)
If Yes
a) Name of the The Cine and Cultural
Activist
b)Address with contact No.
c)Daily Wage.
d)Monthly Wage.
14
Nominee Details
Sl. No:
Name:
Gender:
Relation:
Father/Mother/Spouse/Son/Daughter.
Age:
Marital Status:
15
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 realize 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).
11
Acknowledgment
Smt./Mr.……………………………
Application
No.
……………………………
Date:…………………… an application has been submitted for registration with
“Karnataka Cine and Cultural Activists’ Welfare Board. The application and
supporting documents are subject to verification.
Place :
Date : Signature and seal of the officer
Sanction/Rejection Order
The Application No.………………Date……………… registration with “Karnataka
Cine and Cultural Activists’ Welfare Board and documents are satisfactory. So,
I registered the Cine and Cultural Activists with “Karnataka Cine and Cultural
Activists’ Welfare Board.
Place :
Date : Signature of the registration authority
…………………………………………………………………………………………………………………
……………………………………………………………………………………………………………
For
the
following
reasons
I
have
rejected
the
application
No.:………………………………
Date:…………………………
for
registration
with
“Karnataka Cine and Cultural Activists’ Welfare Board.
1.
2.
3.
Place :
Date : Signature of the registration authority
12
FORM –II
[See sub-rule (1) of rule 7]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Employment Certificate
Shri/Smt./Kum__________________________C/o___________________
residing
at
_________________________________________________,
is
working
as
_____________________________
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/The
Cine
and
Cultural
Activist:__________________________________
2. Address of Organisation/The Cine and Cultural Activist: ________________________
_____________________________________________________________
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 the Cine and Cultural Activist/organisation
FORM –III
[See sub-rule (3)of rule7]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Application for renewal of registration with “Karnataka Cine and Cultural
Activists Welfare Board.
To,
Registering Officer
Tick Which is to be updated in registration details
01
Registration No.
and Date of
registration
02
Previous
registering
officer details
01
Name as Per
Aadhaar:
02
Father/Spouse
Name:
03
Permanent
Address:
__________________Taluk_____________District____________St
ate___________ PIN___________
13
03
(A)
Assembly
Constituency
04
Present Address
__________________Taluk_____________District____________St
ate___________ PIN___________
05
UAN No. (eShram
registration No.)
Can not
changed
05
(A)
Aadhaar No.
Can not
changed
05
(B)
Ration Card
Type and No.
APL/BPL and No.
06
Gender
Can not
changed
Male/Female/Transgender
07
Date of Birth
Can not
changed
DD/MM/YYY
08
Religion
Can not
changed
Hindu/Muslim/Christian/Other
08
(A)
Caste
Can not
changed
SC/ST/OBC/Gen
09
Educational
Qualification
Illiterate/Primary
School/Secondary
School/10th/12th/ITI/Diploma/Degree/Post Graduate
10
Nature of Work
As per List identified by the Board.
11
Experience in
Work at the time
of registration
Year and Month
12
Working with The
Cine and Cultural
Activist/Organisat
ion
Yes/No
12
(A)
If Yes
a) Name of the The Cine and Cultural Activist
b)Address with contact No.
c)Daily Wage.
d)Monthly Wage.
13
Nominee Details
Sl.No:
Name:
Gender:
Relation: Father/Mother/Spouse/Son/Daughter.
Age:
Marital Status:
14
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).
14
Acknowledgment
Smt./Mr.……………………………
Application
No.
……………………………
Date:…………………… an application has been submitted for renewal of
registration with “Karnataka Cine and Cultural Activists Welfare Board. The
application and supporting documents are subject to verification.
Place :
Date : Signature and seal of the officer
Sanction/Rejection Order
The Application No.………………Date……………… renewal of registration with
“Karnataka Cine and Cultural Activists Welfare Board” and documents are
satisfactory. So, I re-registered the Cine and Cultural Activists with
“Karnataka Cine and Cultural Activists Welfare Board.
Place :
Date : Signature of the registration authority
…………………………………………………………………………………………………………
………………………………………………………………………………………………………F
or
the
following
reasons
I
have
rejected
the
application
No.:……………………………… Date:………………………… for renewal of registration
with “Karnataka Cine and Cultural Activists Welfare Board.
1.
2.
3.
Place :
Date : Signature of the registration authority
15
FORM –IV
[See sub-rule (6) of rule7]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Identity Card
Govt. of Karnataka
: Department of Labour
Karnataka Cine and Cultural Activists 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.
:
W
k
i
t
/LTI
R
i t ti
th
it
i
t
Photo
Terms and Conditions
Contact Details
16
FORM –V
[See sub-rule (3) of rule 12]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Application for Accidental Death Claim to Registered Cine and Cultural Activists
Application No:
To,
Claim Authority,
Applicant's/Nominee Personal Details:
1. Name as per Aadhar
2. Date Of Birth & Age
3. Aadhar Number
4. Relationship with
Registered Cine and
Cultural Activists
5. Address
Permanent
Present
6. Mobile Number
7. Date of accident.
8. Date of Death
Registration Details of Cine and Cultural Activists:
1. Name
2. Registration Number:
3. Father/Spouse Name
4. Date Of Birth & Age:
5. 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
Registered
Workers
Photo (if
available)
Applicant/
Nominee
Photo
17
1. Original registration Identity
Card of Cine and Cultural
Activists
2. Employment Certificate
3. FIR copy (Attested by
respected Police Station).
4. Post Mortem report (Attested
by respected Police station or
Hospital)
5. Death Certificate of Cine and
Cultural Activists
6. Aadhar card copy of
Applicant/Nominee and
deceased
7. Ration card (If available)
8. Living Member Certificate of
deceased (Issued by Revenue
Department)
9. 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
18
Sanction/Rejection Order
The Application No.………………Date……………… for accidental death benefit and
documents are satisfactory. So, I paid Rs. ……………………………… under accidental
death benefit for the ……………….. year.
Place :
Date : Signature of the Claim authority
…………………………………………………………………………………………………………………
……………………………………………………………………………………………………………
For the following reasons I have rejected the application No.:………………………………
Date:………………………… for accidental death benefit.
1.
2.
3.
Place :
Date : Signature of the claim authority
FORM –VI
[See sub-rule (3) of rule12]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Application for Accidental Permanent Disability /Medical Reimbursement to
Registered Cine and Cultural Activists
Application No:
To,
Claim Authority,
1
Applicant/Registered Cine and Cultural ActivistsPersonal Details:
1. Name as per Aaadhaar
2. Registration Number:
3. Occupation:
4. Registration Number:
5. Date Of Birth & Age
6. Aadhar Number
7. Address
Permanent
Present
8. Mobile Number
Registered
Workers
Photo
19
9. Date of accident.
10. Claim type
Medical
Permanent
Disability
11. If disability, Disability
certificate No. issued by
medical board.
12. Percentage of Disability.
2
Bank Details of Applicant/Registered Cine and Cultural Activists
Bank Name
Branch Name
Aadhar linked bank
account Number
IFSC Code
3
List of Documents Submitted: (All Attested copy’s) Yes/No
1. Registration Identity Card
2. Employment Certificate
3. FIR copy (Attested by respected Police
Station).
4. Disability certificate issued by medical
board
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 Cine and Cultural
Activists
9. Copy of Applicant/registered Cine and
Cultural Activists 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 Cine and Cultural Activists
20
Acknowledgment
Smt./Mr.……………………………
Application
No.
……………………………
Date:…………………… an application has been submitted for accidental
permanent
disability
/medical
reimbursement
benefit.
The
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 reimbursement benefit and documents are satisfactory. So, I paid Rs.
……………………………… under 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.
1.
2.
3.
Place :
Date : Signature of the claim authority
21
FORM –VII
[See sub-rule (2)of rule 13]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Application for Natural Death Claim to Registered Cine and Cultural Activists
Application No:
To,
claim authority.
1
Applicant/Nominee Personal Details:
1. Name as per Aadhar
2. Date Of Birth & Age
3. Aadhaar Number
4. Relationship with
Registered Cine and
Cultural Activists
5. Address
Permanent
Present
6. Mobile Number
2
Registration Details of Cine and Cultural Activists:
1. Name
2. Registration Number:
3. Father/Spouse Name
4. Date Of Birth & Age:
5. Occupation:
6. Date of Death:
3
Bank Details of Nominee
Bank Name
Branch Name
Aadhaar linked bank
account number
IFSC Code
4
List
of
Documents
Submitted:
(All
Attested
copy’s) Yes/No
1. Original registration Identity
Card of Cine and Cultural
Activist
2. Death Certificate of Cine
and Cultural Activist
Applicant/
Nominee
Photo
Registered
Workers
Photo (If
available)
22
3. Aadhaar card copy of
Applicant/Nominee and
deceased
4. Employment Certificate
5. Living member certificate
issued by revenue
department.
6. Ration card (if available)
7. 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 satisfactory. 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.
1.
2.
3.
Place :
Date : Signature of the Claims Authority
23
FORM –VIII
[See sub-rule (3) of rule 14]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Education Assistance For Registered Cine and Cultural Activists Children
Application No:
To,
Claim Authority,
1
Cine and Cultural Activists 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
2
Education Details of Beneficiary Children:
Sl.
No
Student
Name
Date
Of
Birth
The
class
being
studied
Aaadhaar
Number
School Name,
Address &
Contact
Number
3
Bank Details of Student:
Bank Name:
Branch Name:
Account Number:
IFSC Code:
4
List of Documents Submitted:
1. Registration card
2. Current Year Study Certificate
Student
Photos
24
3. Previous Year Passed Marks Card
4. Aadhaar card copy of Applicant & Student
5. 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
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
The Application No.………………Date……………… for Educational Financial
Assistance
and
documents
are
satisfactory.
So,
I
paid
Rs.
……………………………… under Educational Financial Assistance 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.
1.
2.
3.
Place :
Date : Signature of the claim authority
25
FORM –IX
[See sub-rule (4) of rule15]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Education Assistance For Deceased/Permanent Disabled Registered Cine and
Cultural Activists due to accident
Application No:
To,
Claim Authority.
1
Registered Cine and Cultural Activists personal Details:
1. Name as per Aadhaar
2. Registration Number:
3. Order No. benefits claimed
under Rule ().
4. Date Of Birth & Age
5. Aadhaar Number
6. Relationship with Registered
Cine and Cultural Activists
7. Postal Address
8. Mobile Number
2
Details of registered Cine and Cultural Activists Children’s:
Sl.
No
Student
Name
Date
Of
Birth
The
class
being
studied
Aadhaar
Number
School Name,
Address &
Contact
Number
1
2
3
Bank Details of Students
Student Name as per bank
passbook.
Bank Name
Branch Name
Account Number
IFSC Code
4
List of Documents Submitted:
1. Identity Card
2. Current Year Study Certificate
Student
Photo
26
3. Previous Year Passed Marks Card
4. Order Copy of benefits claimed under Rule ()
5. Aadhaar card copy of registered Cine and
Cultural Activist& Student
6. 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/
registeredCine and Cultural Activists/student
Acknowledgment
Smt./Mr.……………………………
Application
No.
……………………………
Date:…………………… An application has been submitted for educational
assistance for deceased/permanent disabled registered Cine and Cultural
Activistsdue to accident. The application and supporting documents including
signatures are subject to verification.
Place :
Date : Signature and seal of the office
Sanction/Rejection Order
The Application No.………………Date……………… for educational assistance for
deceased/permanent disabled registered Cine and Cultural Activists due to accident
and documents are satisfactory. So, I paid Rs.………………………………
under educational assistance for deceased/permanent disabled registered Cine and
Cultural Activists due to 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 Cine and Cultural Activistsdue to accident.
1.
2.
3.
Place :
Date : Signature of the Claims Authority
27
FORM –X
[See sub-rule (3) of rule 16]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Maternity Benefit for Registered Female Cine and Cultural Activist
Application No:
To,
Claims Authority,
1
Cine and Cultural Activists Personal Details:
1. Name as per Aadhar
2. Registration Number:
3. Date Of Birth & Age
4. Aadhar Number
5. Occupation
6. Address
Permanent
Present
7. Mobile Number
2
Maternity Details of a Cine and Cultural Activists:
1. Date of Delivery
2. Gender of Child
3. Place of birth
4. Whether claiming for
First/Second child
3
Bank Details of registered Cine and Cultural Activists:
Bank Name:
Branch Name:
Account Number:
IFSC Code:
4
List of Documents Submitted:
1. Registration Card
2. Tayi card
3. Birth Certificate of Child
4. Copy of aadhaar linked bank Passbook
Worker
Photo
28
5. 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
Cine and Cultural Activist
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
The Application No.………………Date……………… for maternity benefit and
documents are satisfactory. So, I paid Rs. ……………………………… under
maternity benefit for the ……………….. year.
Place :
Date : Signature of the Claims Authority
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………
For
the
following
reasons
I
have
rejected
the
application
No.:……………………………… Date:………………………… for maternity benefit.
1.
2.
3.
Place :
Date : Signature of the Claims Authority
29
FORM –XI
[See rule 21]
THE KARNATAKA CINE AND CULTURAL ACTIVISTS WELFARE BOARD
Annual Report for the Year ___________.
Sl.No.
Particular
Information
01
Name of the Board
02
Date of Constitution
03
Name of Chairperson
04
Members of the Board
05
Regional Office (If any)
06
No. of Staff of the Board with grade wise
(Including regional office)
07
No. of beneficiaries registered with the Board.
08
No. of beneficiaries registered during the Year.
09
State the number of meetings held with dates
during the year and copy of proceedings to be
attached.
10
Audit identifications during the year.
11
Compliance taken for previous year audit
identifications
12
Internal audit report to be attached along with
financial statements
13
Recommendations by Internal auditor during
previous year and compliances.
14
Cash and Bank balance at the end of 31st March.
(If more than one bank account, mention
separately).
15
Movable and immovable property details.
16
Receipts during the year as per section 14 of the
act.
17
Expenditure as per section 15 of the act.
(mention Scheme wise and other expenditure
details).
18
Court Case details if any.
19
Proposals sent during the year to Govt.
By order and in the name of
Governor of Karnataka,
Suma.S
Under Secretary to Government,
Labour Department.
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Date: 2025.09.25 17:50:43 +05'30'