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La Gazette de L' État de Poudouchéry
The Gazette of Puducherry
PART - II
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®ı Amflºƒˆ ÿƒÀkVF¬˛wÁ\ 2020 } º\ | 12 { No. 23 Poudouchéry Mardi 1 2 Mai 2020
No. Puducherry Tuesday 12th May 2020
(22 Vaisakha 1942)
GOVERNMENT OF PUDUCHERRY
INFORMATION AND PUBLICITY DEPARTMENT
(G.O. Ms. No. 03, Puducherry, dated 4th May 2020)
NOTIFICATION
Whereas, Scheme for Grant of Medical Insurance to the Families
of the Media Persons of the Union territory of Puducherry-2015,
(hereafter referred to as the said Scheme) was notified vide G.O. Ms.
No. 14, dated 18th August, 2015 vide G. O. Ms. No.14, dated 18th August, 2015
of the Department of Information and Publicity, Puducherry and the
renewal Application clause and new Form is to be proposed in order to
facilitate the Media Persons to renew their medical insurance policy and
the benefits;
[209 ] 210 LA GAZETTE DE L'ETAT [PART–II
2. Now, therefore, the Lieutenant-Governor, Puducherry, hereby
makes the following amendment to the "Scheme for Grant of Medical
Insurance to the Families of the Media Persons of the Union territory
of Puducherry-2015", namely:–
(i) Short title and commencement.— (1) This Scheme may be
called "Scheme for Grant of Medical Insurance to the Families of the
Media Persons of the Union territory of Puducherry [Amendment] 2020"
(2) They shall come into force on the date of their notification
in the Official Gazette.
(ii) Amendment.— In clause 6 of the said Scheme, after existing
sub-clause (d), the following sub-clause shall be inserted namely:–
(e) Medical Insurance once given under these Scheme shall
be valid for one year and is renewable on an Application. The
application shall be submitted by the applicant in the Form-I (a)
prescribed by the Directorate, along with the service certificate
as stated in the clause 6 (c) of the said Scheme.
(iii) Amendment.— In the said Scheme, after the existing Form-I,
the following Form (as appended to this notification) shall be inserted.
3. This issues with the concurrence of the Finance Department
vide their ID.No. 2094/FD/F3/2019-20, dated 03-03-2020.
(By order of the Lieutenant-Governor)
M.M. VINAYARAJ,
Under Secretary to Government
(Information and Publicity).
211
PART–II] LA GAZETTE DE L'ETAT
APPENDIX
FORM-I (a)
[See Clause 6 (e)]
1. N a m e o f t h e A p p l i c a n t a n d :
Designation
2. Date of Birth and Age of applicant : (with a proof of Date of Birth)
3. Address
Present
:
Permanent
:
4. P e r i o d o f R e s i d e n c e i n t h e :
Present Address
5. Name of the Newspaper/Journal/ : Agency in which the applicant has worked.
6. Periodicity :
7. Whether the applicant served :
as full time employee
8. Whether the applicant is an : A c c r e d i t e d M e d i a P e r s o n ( I f y e s , p l e a s e f u r n i s h t h e details)
9. Details of Health Insurance P o l i c y a l r e a d y S a n c t i o n e d ( c o p y o f t h e P o l i c y t o b e furnished)
1. Insurance Policy No. :
2. Premium amount paid by :
the Government
10. Details of amount claimed by : the applicant if any, from the
Insurance Agency 212 LA GAZETTE DE L'ETAT [PART–II
DECLARATION
I, .................................................... son/daughter/wife of
..................................................... hereby solemnly affirm and declare that
the information furnished above are true, complete and correct to the
best of my knowledge and belief. I have not suppressed any material
fact that will disentitle me for the renewal of Medical Insurance.
I, further declare that I have not opted for/availed of any other
Family Health Insurance Scheme operated by the Government of
Puducherry.
Place :
Signature of the Applicant
Date :
————
online publication at "https://styandptg.py.gov.in" Published by The Director, Government Press Printed at: Government Central Press, Puducherry. Posted at: Puducherry HPO on every Tuesday