Panaji, 3rd January, 2019 (Pausa 13, 1940)

SERIES I No. 40

Reg. No. G-2/RNP/GOA/32/2018-20

RNI No. GOAENG/2002/6410

PUBLISHED BY AUTHORITY

NOTE

There are two Extraordinary issues to Official Gazette, Series I No. 39 dated 27-12-2018, namely:—

(1) Extraordinary dated 31-12-2018 from pages 2357 to 2358, Not. No. CCT/26-2/2018-19/43/3283 regarding the

Amendment of Government Notification dated 13-8-2018, from Department of Finance (Commercial Taxes).

(2) Extraordinary (No. 2) dated 31-12-2018 from pages 2359 to 2414, from Department of Finance (R&C), notifications

regarding amendment of GST.

INDEX

Department

Notification/Order

Subject

Pages

1. Agriculture

Not.- 3/3/Hort/SSS/4/2018-19/

Assistance for creation of Irrigation

2415

Dir. & ex officio Joint Secy.

/D.Agri/218

Infrastructure-2018.

2. Civil Aviation

Not.- 121/DOCA/MADA Rules/

Goa (Mopa Airport Development Authority)

2420

Dir. & ex officio Joint Secy.

/2018

Rules, 2018.

3. Civil Supplies & Consumer

Not.- DCS/S/Ker/PF/2018-19/

Revised fixation of wholesale & retail price

2420

Affairs

/356

of Superior Kerosene Oil.

Dir. & ex officio Joint Secy.

4. Law & Judiciary

Not.- 8/8/2018-LD(Estt.)/2401

Online mandate for Property Registration/

2421

Under Secretary

/Document Registration.

5. Personnel

Ord.- 15/11/96-PER/Vol.I/3438

Creation of posts.

2422

Under Secretary

6. Revenue

Not.- 16/1/10/2018/Rev-I/2672

Amendment of Government Notification dated

2423

Under Secretary

16-3-2011.

7.a.Urban Development

Ord.- DMA/Accts/27/2017/

Creation of posts.

2423

Director

/PART/2860

b. —do—

Ord.- DMA/Accts/27/2017/

Final sanctioned staff strength.

2424

/PART/2861

8. Women and Child Dev.

Not.- 2-280-SL-2012-DWCD/

Griha Aadhar Scheme.

2435

Dir. & ex officio Joint Secy.

/8666

2415

Suggestions are welcomed on e-mail: dir–[email protected]

GOVERNMENT OF GOA

Department of Agriculture

Directorate of Agriculture

Notification

3/3/Hort/SSS/4/2018-19/D.Agri/218

Irrigation to crops is of vital importance to

ensure higher productivity of agricultural and

horticultural crops. Creation of assured source

irrigation

and

suitable

network/

/infrastructure for effective distribution of

water is of utmost importance for sustainable

growth of agriculture along with conservation

of precious natural resources of water.

Irrigation infrastructure ensures multiple

cropping all around the year, providing

employment and income to the farming

community. The Government by extending

sizeable assistance for Creation of Irrigation

Infrastructure intends to help farmers in

achieving the goal of doubling farmers’ income

by 2022.

Government of Goa is pleased to introduce

modified State Sector Scheme – “Creation of

Irrigation Infrastructure-2018”.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2416

1. Short title and commencement.— (i) The Scheme shall be called State Sector Scheme

“Assistance for Creation of Irrigation Infrastructure-2018”.

(ii) The Scheme shall come into force with immediate effect and shall remain in force till it is

withdrawn.

(iii) The Scheme shall cover all Talukas of the State of Goa.

2. Objectives.— (i) To create Irrigation Infrastructure to support Horticultural and other

Agricultural Activities.

(ii) To support the farmer for taking more than one crop during the year to enhance his

earnings and livelihood.

(iii) To enable the farmer to obtain higher yields and get more income.

(iv) To enhance the conservation, distribution and utilization of water to achieve the goal

“Per Drop More Crop”.

(v) To protect the farmer from crop loss due to breaks in monsoons and drought in the current

era of climate change.

3. Components.— (i) Digging and Construction of Irrigation Well.

(ii) Installation of Irrigation Pump.

(iii) Assistance for Add-on-Gadgets.

(iv) Assistance for Water Conveying Pipeline.

(v) Assistance for Micro Irrigation.

(vi) Assistance for Water Storage Tank.

(vii) Assistance for HDPE/UPVC Water Storage Tank.

4. Eligibility criteria for selection of farmers.— (i) All owners of land cultivating or willing to

cultivate Agricultural/Horticultural Crops holding minimum land of 0.125 ha. with net area

under crop of 0.10 ha. are eligible, provided the applicants name reflects in Krishi Card abstract

as owner or having right for cultivation. However, private companies/corporates will not be

considered under the scheme.

(ii) The farmers should be intending to practice double cropping or inter cropping including

multilevel cropping.

5. Pattern of Assistance.— (i) Digging and Construction of Irrigation Well.

The farmers will be provided with financial assistance of 75% of the cost as subsidy as per

the farm size/area and dimensions of the well for digging and construction of new well to bring

more area under irrigation.

The pattern of assistance for different dimensions of well and land holding is as given below:

A. Circular well:

Sr.

Open well with Laterite

Minimum

Minimum land

Maximum eligible

No.

Masonary/RCC ring with

depth (Mtrs.)

holding (Ha.)

subsidy (Rs.)

minimum Diameter (Mtrs.)

1.5-1.75

0.125-0.2

60,000

1.76-1.99

0.125-0.2

70,000

2.0-2.25

0.2-0.4

85,000

2.26-2.50

0.2-0.4

1,00,000

2.51-3.0

0.2-0.4

1,15,000

3.01-3.5

0.4-1.0

1,30,000

3.51-4.0

0.4-1.0

1,45,000

4.01-4.5

0.4-1.0

1,60,000

4.51-5.0

1 ha. and above

1,80,000

10.

5.01 and above

7.1 and above

1 ha. and above

2,00,000

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2417

B. Rectangular/Square Well.— In case of square or rectangular well the assistance would

be provided for the average means of length and breath dimensions.

Sr.

Square/Rectangular

Minimum

Minimum land

Maximum eligible

No.

open well of Laterite Masonary with

depth (Mtrs.)

holding (Ha.)

subsidy (Rs.)

surface area M2 (length x breath)

2.25-3.06

0.125-0.2

60,000

3.01-3.99

0.125-0.2

70,000

4.00-5.06

0.2-0.4

85,000

5.07-6.25

0.2-0.4

1,00,000

6.26-9.00

0.2-0.4

1,15,000

9.01-12.25

0.4-1.0

1,30,000

12.26-16.00

0.4-1.0

1,45,000

16.01-20.25

0.4-1.0

1,60,000

20.26-25.09

1 ha. and above

1,80,000

10.

25.01 and above

7.1 and above

1 ha. and above

2,00,000

C. Bore Well/Tube Well.—

Sr.

Borewell/Tubewell with

Farm size/total land

Maximum

No.

minimum internal diameter

holding to be irrigated

eligible subsidy (Rs.)

(ha.)

50 mm. bore

upto 0.5 ha.

75,000

100 mm. bore

between 0.5-1.0 ha.

1,25,000

150 mm. bore

more than 1.0 ha.

1,50,000

Note: The subsidy would be sanctioned maximum upto 75% of standard cost fixed by the committee or

maximum 75% of actual cost or upto maximum eligible subsidy fixed for different sizes/types of well as

detailed above at A, B and C – whichever is less.

In case of dimensions different from those specified above the nearest lower dimension will

be considered in case of diameter, width, depth or surface area.

The farmer shall execute and complete the construction of well on his own or through contractors.

(ii) Installation of Irrigation Pump.—

a. Assistance will be provided for installation of new water pump set (electric/diesel/

/petrol/solar) and for replacement of existing water pump sets (electric/diesel/petrol) in

case of up-gradation of existing irrigation systems or replacement of old pump of minimum

five years for better efficiency.

b. In case of installation of new pumpsets with capacity upto 5 HP, assistance will be upto

90% of the approved cost; whereas water pumpsets above 5 HP will be assisted upto 50% of

the standard cost. The electricity connection has to be new in such cases.

c. The cost norms will be as approved by the Departmental Committee from time to time.

d. Assistance @ 50% of standard cost will be provided for replacement of all the pumpsets

which are more than 5 years old, irrespective of their capacity.

e. Pumps required to be replaced due to up-gradation of irrigation system such as

installation of sprinkler/drip irrigation or to increase area coverage will be provided assistance

upto 90% as proposed for fresh installation at (ii) (b) above.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2418

iii. Assistance for Add-on Gadgets.— (a)

Assistance will be provided for add-on gadgets

like remote control, timers, etc., upto 50% of

the cost limited to Rs. 5000/- whichever is less.

(b) Assistance will be provided for add-on

gadgets like fertigation tank, sand filters, etc.,

(optional components of Micro Irrigation), upto

75% of the standard cost in case of sprinkler

irrigation systems and upto 90% of standard

cost in case of drip irrigation system or of the

actual cost whichever is less.

iv. Assistance for Water Conveying

Pipeline.— (a) Farmers installing water

conveying pipeline will be provided assistance

upto 50% of the actual cost limited to

Rs. 20,000/- per ha. and a maximum assistance

of Rs. 1,00,000/- per farmer.

(b) The farmers shall invariably use rigid

PVC or HDPE pipeline or any other material

as recommended from time to time of

minimum 32mm. diameter.

v. Assistance for Micro Irrigation.— (a)

An assistance to the extent of 90% of

standard cost for installation of drip

irrigation system and to the extent of 75%

of standard cost for installation of

sprinkler irrigation system shall be

provided to farmers subject to indicative

costs

per

hectare

approved

Government of India from time to time for

different crops/spacing and systems.

(b) Indicative costs per hectare for drip and

sprinklers of Government of India are far lower

than those prevailing in Goa due to higher cost

of system, labour costs, etc.

Hence, additional weightage of 75% will be

permitted over and above indicative cost of

Government of India based on which the

standard cost will be arrived for calculating

the maximum subsidy for drip and sprinkler

system under component-Assistance for

Micro Irrigation under State Sector scheme.

adjusted within the above assistance and only

balance assistance would be provided under

this State Sector scheme component.

In case, no assistance is provided under GOI

for this component, the entire assistance shall

be paid under State Sector.

(d) Subsidy will be released after the system

is installed, commissioned and works to the

satisfaction of the farmer. Subsidy would be

provided based on the actual area covered

under the system.

vi. Assistance for Water Storage Tank.— (a)

Cultivators holding minimum 0.1 ha. area

under agriculture shall be provided with 50%

subsidy on the standard cost for digging &

construction of pond for storage of water for

irrigation.

(b) The farmer can opt for any size of pond

as per the need of the crop and subsidy will

be provided on pro rata basis.

admissible for subsidy shall be 10m³ and

maximum 100m³. However, this may be

relaxed in special cases such as community

farming projects.

(d) The standard for construction shall be

Rs. 2000/- per m³ with 50% subsidy thereon of

Rs. 1000/- per m³.

vii. Assistance for HDPE/UPVC Water

Storage Tank.— (a) Cultivators having land

holding of 0.05 ha. to 0.15 ha. under vegetable

or seasonal flower cultivation shall be provided

with 50% subsidy for installation of over head/

/ground level HDPE/UPVC water storage tank

limited to maximum capacity of 1000 ltrs. and

the maximum assistance limited to Rs. 3500/-.

6. Format for Application.— The application

form for the individual components shall be

as per the format prescribed by the

Department from time to time.

7. Documents required to be attached

alongwith Application.— (i) Documents to be

attached with the application shall be as per

the guidelines for each component in the

circular from time to time.

(ii) In case of digging and construction of

new well, the applicant will have to submit

valid

permit

from

Water

Resources

Department under Goa Ground Water

Regulation Act, for sinking of well.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2419

(iii) In case of installation of new pump,

farmer shall submit the payment receipt

towards release of new connection and copy of

demand note or copy of letter of release of new

connection from the Electricity Department.

(iv) In case of replacement of pump, farmer

shall submit copy of recent electricity bill.

8. Guidelines and procedures for sanction.—

(i) The scheme shall be monitored and

executed by Horticulture Section of the

Directorate of Agriculture under the control of

Deputy Director of Agriculture (Horticulture).

(ii) The interested cultivators shall submit

his application to the Zonal Agriculture Offices

in the prescribed format along with copy of

Krishi Card, copy of survey plan with sketch

of the proposed irrigation infrastructure and

quotation for estimated expenditure.

(iii) Prior approval of Directorate of

Agriculture shall be obtained for availing

benefits for all the components of the Scheme.

(iv) The Zonal Agriculture Officer shall get

the site inspected and issue Administrative

Approval for the cases meeting the norms of

the scheme wherein the admissible subsidy

would be upto Rs. 1.5 lakhs.

(v) The Zonal Agriculture Officer shall

submit the cases to District Agriculture Officer

along with recommendations for issue of

Administrative Approval wherein the

admissible subsidy would be above Rs. 1.5

lakhs.

(vi) Farmers shall carry out the work as

per the approval of the Zonal Agricultural

Officer/Directorate of Agriculture, within

the limits permitted by Water Resources

Department. After completion of digging/

/construction of well, the applicant shall

submit the claim along with completion

report,

the

expenditure

vouchers/

/bills etc. to the Zonal Agriculture Office for

settlement. If the farmer has obtained loan

from the bank, the completed case papers

shall be submitted by farmer along with the

voucher/receipt through the Bank Manager

to Zonal Agricultural Office.

(vii) The project/site will be inspected by

Zonal Agriculture Officer or his representative.

Zonal Agriculture Officer shall verify the

bills, certify the completion of the well and the

expenditure incurred.

(viii) Zonal Agricultural Officer shall issue

completion certificate along with his

Inspection Report and forward the claim to

District Agriculture Officer with reco-

mmendations for release of subsidy as per the

pattern of assistance.

(ix) District Agriculture Officer shall verify

the claim to be in order, inspect the irrigation

infrastructure if required and the correctness

of vouchers before finalization and sanction.

(x) The District Agricultural Officer shall

accord expenditure sanction, draw and

disburse the subsidy within his powers and

prefer the bills for release by the Directorate

of Accounts.

(xi) Preference shall be given for SC and ST

farmers.

(xii) Any assistance provided under any

Centrally Sponsored or Central Sector scheme

of Government of India would be adjusted

within the above assistance and the balance

assistance would be provided under this State

Sector scheme.

In case no assistance is provided under

Centrally Sponsored or Central Sector scheme

of Government of India for any of the above

components, the entire assistance shall be

paid under State Sector.

9. Checks adopted by the department for

verification of cases.— (i) 10% of cases will be

randomly inspected by District Agriculture

Officer/Horticulture section.

10. Undertaking.— The applicant farmers

shall submit an undertaking that they will

utilize the infrastructure created under the

scheme with Government assistance at least

for next ten years entirely for the cultivation

of crops.

11. Interpretation.— If any question arises

regarding interpretation of any clause, word,

expression of the scheme, the decision shall

lie with the Government, which shall be final

and binding on all concerned.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2420

12. Redressal of Grievances and Disputes.—

Grievances if any arising out of the

implementation of this scheme shall be heard

and decided by the Minister for Agriculture

and the decision of the Minister for Agriculture

in this regard shall be final and binding on all

concerned.

The Minister of Agriculture shall have the

powers to grant any relaxation in general or

on case to case basis regarding procedure and

guidelines of the scheme in the interest of

promoting Creation of Irrigation Infrastructure

in the State of Goa.

Power to grant relaxation as regards to

administrative procedures in general or on

case to case basis shall lie with Director of

Agriculture and his decision in this regard shall

be final and binding on all concerned.

This issues with the concurrence of Finance

Expenditure Department under U. O. No. Fin

(Exp) 1400058858 dated 20-11-2018.

This supersedes the earlier Notification

No. 3/3/Hort/SSS/1/2016-17/D.Agri/126 dated

26-07-2016, including the part pertaining to

the component “Creation of Irrigation

Infrastructure”.

By order and in the name of Governor

of Goa.

Madhav Kelkar, Director & ex officio Jt.

Secretary (Agriculture).

Tonca-Caranzalem, 31st December, 2018.

———ttt———

Department of Civil Aviation

Directorate of Civil Aviation

Notification

121/DOCA/MADA Rules/2018

In exercise of the powers conferred by

section 16 of the Goa (Mopa Airport

Development Authority) Act, 2018 (Goa Act

10 of 2018) and all other powers enabling it

in this behalf, the Government of Goa hereby

makes the following Rules, namely:—

1. Short title and commencement.— (1)

These Rules may be called the Goa (Mopa

Airport Development Authority) Rules, 2018.

(2) They shall come into force at once.

2. Definitions.— (1) In these rules unless

the context otherwise requires,—

(a) “Act” means the Goa (Mopa Airport

Development Authority) Act, 2018 (Goa

Act 10 of 2018);

(b) “Member Secretary” means member

secretary of the Authority.

(2) Words and expressions used and not

defined in these rules but defined in the Act

shall have the meanings respectively

assigned to them in the Act.

3. Application for obtaining clearance.— (1)

An application or proposal for obtaining

clearance under the relevant law shall be

addressed to the Member Secretary.

(2) The Authority shall, after receipt of the

proposals for clearances under sub-rule (1)

above, examine the same in light of the

provisions of the relevant State law and issue

clearances without loss of time after satisfying

itself that such clearances could be issued to

the Mopa Greenfield International Airport

Project under relevant State law.

4. Conditions of service of officers and

employees of the Authority.— (1) All officers

and employees of the Authority shall be on

deputation drawn from the State Government

or from Government of India.

(2) They shall be governed by their

respective deputation rules applicable to them.

By order and in the name of the

Governor of Goa.

Dr. Suresh Shanbhogue, Director & ex officio

Joint Secretary (Civil Aviation).

Porvorim, 27th December, 2018.

———ttt———

Department of Civil Supplies & Consumer

Affairs

Notification

DCS/S/Ker/PF/2018-19/356

In pursuance of clause 3 read with sub-

clause (d)(i) of clause 2 of Kerosene Fixation of

Ceiling Price Order (1993), the Government of

Goa hereby directs that maximum wholesale

& retail price for domestic purpose of Superior

Kerosene Oil stands revised as under with effect

from 16-12-2018. This Notification supersedes

earlier Notification No. DCS/S/KER/PF/2018-

-19/322 dated 23-11-2018.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2421

Sr.

Taluka

Wholesale Price

Retail Price

No.

per kilo litre

per litre

including GST

& Green Cess

Existing

Revised

Existing

Revised

Tiswadi

Rs. 28530.29

Rs. 29187.49

Rs. 30.88

Rs. 31.50

Chorao

Rs. 28561.79

Rs. 29218.99

Rs. 30.88

Rs. 31.50

Diwar

Rs. 28561.79

Rs. 29218.99

Rs. 30.88

Rs. 31.50

Salcete

Rs. 28037.92

Rs. 28695.12

Rs. 30.38

Rs. 31.00

Bardez

Rs. 28685.77

Rs. 29342.97

Rs. 31.13

Rs. 31.75

Corjuvem

Rs. 28685.77

Rs. 29342.97

Rs. 31.13

Rs. 31.75

Mormugao

Rs. 27850.05

Rs. 28507.25

Rs. 30.13

Rs. 30.75

Ponda

Rs. 28141.58

Rs. 28798.78

Rs. 30.38

Rs. 31.00

Quepem

Rs. 28290.59

Rs. 28947.79

Rs. 30.63

Rs. 31.25

Bicholim

Rs. 28698.73

Rs. 29355.93

Rs. 31.13

Rs. 31.75

Pernem

Rs. 28990.26

Rs. 29647.46

Rs. 31.38

Rs. 32.00

Canacona

Rs. 28588.60

Rs. 29245.80

Rs. 30.88

Rs. 31.50

10.

Sanguem

Rs. 28433.11

Rs. 29090.31

Rs. 30.88

Rs. 31.50

11.

Satari

Rs. 28588.60

Rs. 29245.80

Rs. 30.88

Rs. 31.50

12.

Dharbandora

Rs. 28433.11

Rs. 29090.31

Rs. 30.88

Rs. 31.50

By order and in the name of the Governor of Goa.

Sandhya Kamat, Director & ex officio Jt. Secretary (Civil Supplies & Consumer Affairs).

Panaji, 26th December, 2018.

———ttt———

Department of Law & Judiciary

Law (Establishment) Division

Notification

8/8/2018-LD(Estt.)/2401

As required under the Ease of Doing Business, Government of Goa, Law (Establishment)

Division and Registration Department hereby mandates that all applications pertaining to

“Property Registration/Document Registration” shall be accepted and processed online only

without requiring the applicant to physically submit a copy of the application or associated

supporting documentation including draft deed. The Department staff (all Sub-Registrar offices)

are hereby instructed to process applications through the online mode only. The applicants

may also choose to make online payment of Stamp Duty and Registration Fee and may thereafter

avail the facility of generation of appointment date and time through the system.

Further, it is also mandated that all queries against applicants’ applications (if any) should

be submitted to the applicants only once and within 7 days of receipt of the application.

This Notification shall come into force with effect from the 1st day of January, 2019.

This issues in supersession to earlier Notification of even number dated

11-12-2018 and all the property registrations initiated under National Generic Document

Registration System (NGDRS) from 13-12-2018 are hereby ratified by the Government.

By order and in the name of the Governor of Goa.

Anju S. Kerkar, Under Secretary, Law (Estt.)

Porvorim, 31st December, 2018.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2422

Department of Personnel

Order

15/11/96-PER/Vol.I/3438

Read:- Order No. 9/10/HLEC/2018-ARD dated 14-08-2018.

Sanction of the Government is hereby accorded for creation of the following posts as per

the details shown below:—

Sr. No.

Designation of the post

Pay Scale

No. of posts created

Non-Ministerial (Non-Lapsable) Posts

Dy. Collector & SDO

Level-10

Accountant

Level-06

Field Surveyor

Level-04

Talathi

Level-02

Ministerial (Lapsable) Posts

Aval Karkun

Level-05

Head Clerk

Level-06

Upper Division Clerk

Level-04

Junior Stenographer

Level-04

Lower Division Clerk

Level-02

10.

Bailiff

Level-01

11.

Peon (Multi Tasking Staff)

Level-01

Total

The expenditure on the creation of above posts would be met from the Budget Head under

Demand No. 15, 2053—District Administration; 00; 093—District Establishment;

01—Civil Administration (North Goa); 01—Salaries (Non Plan).

This issues with the approval of the High Level Empowered Committee (H.L.E.C.) constituted

with the approval of the Council of Ministers in the XXth meeting held on 08-11-2017 vide

Order No. 1/1/2017-Addl. Secy(PER) dated 22-11-2017 issued by Department of Personnel

and conveyed vide order 9/10/HLEC/2018-ARD dated 14-08-2018, issued by the Department

of Administrative Reforms, Secretariat.

By order and in the name of the Governor of Goa.

Harish N. Adconkar, Under Secretary (Personnel-I).

Porvorim, 5th November, 2018.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2423

Department of Revenue

Notification

16/1/10/2018/REV-I/2672

In exercise of the powers conferred by sub-section (1) of section 3 of the Goa Land

Revenue Code, 1968 (Act No. 9 of 1969) and all other powers enabling it in this behalf, read

with section 21 of the General Clauses Act, 1897 (10 of 1897), the Government of Goa hereby

amends the Government Notification No. 16-15-2010/RD dated 16-3-2011, published in the

Official Gazette, Series I No. 51 dated 17-3-2011 (hereinafter referred to as the “principal

Notification”) as follows, namely:—

In the principal Notification, in the Schedule, against serial number 4, in column 3, for the

word “Bicholim”, the word “Satari” shall be substituted.

This Notification shall come into force with immediate effect.

Note: The principal Notification was subsequently amended by following Notifications, namely:—

(1) Notification No. 16/15/2010-RD/2342 dated 20-5-2011, published in the Official Gazette, Series I

No. 8 dated 26-5-2011.

(2) Notification No. 16/15/2010-RD dated 15-6-2012, published in the Official Gazette, Series I No. 12

dated 21-6-2012.

(3) Notification No. 37/2/2014-RD dated 22-1-2015, published in the Official Gazette, Series I No. 43

dated 23-1-2015.

(4) Notification No. 37/2/2014-RD dated 19-02-2015, published in the Official Gazette, Series I No. 48

dated 26-2-2015.

(5) Notification No. 16/1/10/2018/REV-I/1711 dated 06-09-2018, published in the Official Gazette, Series I

No. 24 dated 15-9-2018.

By order and in the name of the Governor of Goa.

Sagun R. Velip, Under Secretary (Revenue-I).

Porvorim, 26th December, 2018.

———ttt———

Department of Urban Development

Municipal Administration

Order

DMA/Accts/27/2017/PART/2860

Sanction of the Government is hereby accorded for creation of the following posts as per

the details shown below:—

Sr. No.

Designation of the post

Pay Scale

No. of posts created

Non-Ministerial (Non-Lapsable) Posts

Dy. Director

Pay Matrix 9, Level 1

Assistant Engineer

Pay Matrix 7, Level 1

Jr. Engineer

Pay Matrix 5, Level 1

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2424

Ministerial (Lapsable) Posts

UDC

Pay Matrix 4, Level 1

Jr. Stenographer

Pay Matrix 4, Level 1

LDC

Pay Matrix 2, Level 1

Multi Tasking Staff

Pay Matrix 1, Level 1

Total

The expenditure on the creation of above posts would be met from the Budget Head:—

(i) 2217/00/800/01/01 (for Non-Ministerial posts) and

(ii) 2217/00/800/02/01 (for Ministerial posts).

This issues with the approval of the High Level Empowered Committee (H.L.E.C.) constituted

with the approval of the Council of Ministers in the XXth meeting held on 08-11-2017 vide

Order No. 1/1/2017-Addl. Secy(PER) dated 22-11-2017 issued by the Department of Personnel.

Approval of the High Level Empowered Committee (H.L.E.C.) is conveyed vide letter No.

9/14/IDCO/2018-ARD/406 dated 18-12-2018, issued by the Department of Administrative

Reforms, Secretariat.

By order and in the name of the Governor of Goa.

R. Menaka, IAS, Director (Urban Development).

Panaji, 27th December, 2018.

————

Order

DMA/Accts/27/2017/PART/2861

In supersession of all the previous orders for creation/revival/redesignation/upgradation

of the various posts, Government is pleased to indicate the final sanctioned staff strength of

the Department as under for the next five years:—

Sr. No.

Designation

Total Strength

Non-Ministerial (Non-Lapsable) posts

Director

Additional Director

Dy. Director

Assistant Accounts Officer

Research Assistant

Accountant

Assistant Engineer

Junior Engineer (Re-designated from

Engineering Assistant)

Investigator

10.

Head Clerk

11.

UDC

12.

Jr. Stenographer

13.

LDC

14.

Driver

15.

Multi Tasking Staff

Total

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2425

One Post of Head Clerk, one post of

Engineering Assistant, two posts of Accounts

Clerk/UDC, one post of UDC, three posts of

LDC, one post of Driver and two posts of Peons

which were existing temporary posts are

converted to permanent posts. One post of

LDC and one post of Peon which lapsed after

1st April, 2012 has been revived.

This issues with the approval of the High

Level Empowered Committee (H.L.E.C.)

constituted with the approval of the Council

of Ministers in the XXth meeting held on

8-11-2017 vide Order No. 1/1/2017-Addl. Secy.

(PER) dated 22-11-2017 issued by the

Department of Personnel.

Approval of the High Level Empowered

Committee (H.L.E.C.) is conveyed vide

letter No. 9/14/IDCO/2018-ARD/406, dated

18-12-2018, issued by the Department of

Administrative Reforms, Secretariat.

By order and in the name of the

Governor of Goa.

R. Menaka, IAS, Director (Urban Develop-

ment).

Panaji, 27th December, 2018.

———ttt———

Department of Women & Child Development

Directorate of Women & Child Development

——

Notification

2-280-SL-2012-DWCD/8666

GRIHA AADHAR SCHEME

Read:- (1) Notification No. 2-280-SL-2012-

DW&CD/4291 dated 01-10-2012.

(2) Amendment Notification No. 2-280-

-SL-2012-DW&CD/6524

dated

26-11-2012.

(3) Amendment Notification No. 2-280-

-SL-2012-DW&CD/09562 dated

30-10-2014.

(4) Amendment Notification No. 2-280-

-SL-2012-DW&CD dated 18-02-2015.

(5) Amendment Notification No. 2-280-

-SL-2012/DW&CD/Part file/362

dated 14-07-2015.

(6) Amendment Notification No. 2-280-

-SL-2012-DW&CD/362

dated

20-01-2016.

(7) Amendment Notification No. 2-280-

-SL-DW&CD/Part file/2461 dated

15-03-2016.

(8) Amendment Notification No. 2-280-

-SL/DW&CD/Part file/4690 dated

22-06-2016.

(9) Amendment Notification No. 2-280-

-SL-2012-DWCD/Part File/1590

dated 04-07-2017.

The Government of Goa hereby notifies the

amended Griha Aadhar Scheme.

Objective of the Scheme.— The objective of

the scheme is to address the problem of

spiraling prices and to provide support to the

housewives/homemakers from middle, lower

middle and poor section of the society, to

maintain a reasonable standard of living for

their families. Under this scheme a monthly

disbursement of an amount as prescribed

under the scheme will be provided every

month directly at the hands of the

housewives/homemakers to achieve the

objective.

1. Short title and commencement.— (a) This

scheme shall be called “Griha Aadhar

Scheme”.

(b) This amended scheme shall replace the

existing scheme and come into force with

immediate effect.

2. Eligibility and other conditions.— Any

married woman above the age of 18 years, who

fulfils all of the following conditions is eligible

to apply:–

(a) She should be a resident of Goa for the

last fifteen years; and

(b) The gross income of the husband and

wife, taken together should not exceed

Rs. 3,00,000/- per annum.

those married woman who or whose husband

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2426

is employed in any of the following entities on

regular basis (contract daily wages are

excluded):–

(i) Government of Goa or its’ Corporation

or Autonomous organization funded by

State Government.

(ii) Government of India or any other

State Government or its Corporations/

/Autonomous bodies.

(iii) Scheduled Banks but excluding Co-

operative banks (subject to actual income

in case of Co-operative Banks).

(d) The married woman or her husband

shall not be in receipt of benefit under the

Dayanand Social Security Scheme (DSSS) rolled

out by Directorate of Social Welfare,

Government of Goa. Notwithstanding this

proviso, widow with minor child who is in

receipt of benefit under the Dayanand Social

Security Scheme (DSSS) rolled out by

Directorate of Social Welfare, Government of

Goa shall be eligible for benefit under this

scheme.

Note 1: The term ‘married woman’ includes a

widow and a divorcee. In such cases the gross

income of the beneficiary should not exceed

Rs. 3,00,000/- per annum.

Note 2: The term ‘gross income’, means the income

receivable by the beneficiary as salary, any sort of

remuneration, any sort of earnings from profession,

agriculture or business or any other income from any

other sources; before computing any other amount

accounted towards statutory, essential and other

deductions required to be done from the gross

income.

3. Financial Assistance.— The beneficiary

under the scheme shall be paid an amount of

Rs. 1,500/- per month, as financial assistance

w.e.f. payment of September, 2016.

4. Application procedure.— (a) The eligible

beneficiary shall apply to the Director of

Women and Child Development, Panaji-Goa in

the prescribed form (Annexure-A), complete

in all respects with the self-certified copies of

the following documents:

(i) Aadhar Card,

(ii) Marriage Certificate;

In case of non-availability of Marriage

Certificate, alternate proof of marriage (like

certificate issued by the religious institution

where the marriage was solemnized etc.) or

Birth Certificate of the child indicating the

name of the beneficiary as the mother or any

other documentary evidence. All such cases

shall be referred to the Committee constituted

in terms of clause 6 (a) for decision.

However, Marriage Certificate shall be an

essential document in case of beneficiaries

who are getting married, on or after the date,

this scheme comes into force. In such cases,

alternate documents as indicated above shall

not be accepted and no relaxation shall be

granted. Such cases shall not be referred to

the Committee and the application shall be

rejected.

(iii) Proof of present residential address

(which may include a ration card; Election

Photo Identity Card (EPIC), or any such

document which establishes the present

address);

(iv) 15 years Residence Certificate issued

by Mamlatdar of the Taluka concerned.

Alternatively, the applicant may submit a

certificate in the prescribed form (Annexure-

C), issued by a Gazetted Officer of the State

Government, certifying that the applicant is a

resident of the State of Goa for the last 15 years:

Provided that in case of a married women

who is originally native from outside the State

and has married with a person who has been

residing in Goa for last fifteen years, the

applicant shall submit her certificate of

residence in Goa for a minimum period of 3

years along with her birth certificate as a

proof that she is native of outside Goa and

15 years Residence Certificate of her

husband.

(v) Income Certificate issued by the

Competent Authority, which may also include

Salary Certificate/Income Certificate, in the

prescribed form (Annexure-D) issued by an

employer.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2427

In such cases where the employer issues a

salary certificate; the unit or firm or

establishment of the employer should be

registered with the appropriate authorities

concerned and the employer should be

contributing towards Employees’ Provident

Fund and/or Employees’ State Insurance

Scheme and/or any other statutory scheme for

its employees.

The applicant is required to submit the

Income Certificate/Salary Certificate as

follows:

(a) In the case of the applicant being

employed, then the income certificate/salary

certificate in the prescribed form (Annexure-

D) of both the husband and the applicant shall

be submitted. In the event the husband is not

able to obtain a salary certificate, being

unemployed or self-employed or carrying out

any other occupation, business, profession or

trade; then the individual Income Certificate

of the husband, issued by the Competent

Authority shall be submitted.

(b) In the case of the applicant being a

widow or a divorcee, then the income

certificate/salary certificate in the prescribed

form (Annexure-D) of the applicant shall be

submitted.

unemployed or self-employed or carrying out

any other occupation, business, profession or

trade; then the individual Income Certificate,

issued by the Competent Authority shall be

submitted.

(d) In the event of the applicant being not

in a position to obtain the Income Certificate

or Salary Certificate as above, then the

applicant should submit a Certificate issued

by a Gazetted Officer of the State Government,

certifying that the applicant is purely a

housewife/homemaker. Alongwith this

Certificate, the applicant should submit a self-

declaration in form (as per Annexure-E) on a

non-judicial stamp paper of Rupees twenty

only, duly certified and attested before a

Gazetted Officer of the State Government,

declaring therein that the annual income from

all sources does not exceed Rs. 3,00,000/-. This

self-declaration need not be notarized.

(vi) Attested copy of savings bank account

pass book (with IFSC and MICR details); and

(vii) Birth certificate of the child along with

life certificate (in case of widow who is DSSS

beneficiary).

(b) The applications shall be scrutinized and

sanction will be issued by the Director of

Women and Child Development. The Director

of Women and Child Development shall

establish facilitation centres in the taluka level

offices for processing the application forms. A

maximum number of upto 15000 applications

shall be sanctioned in a calendar year.

assistance of Rs. 1500/- (Rupees one thousand

five hundred only) shall be paid every month

directly into the savings bank account of the

eligible beneficiary by ECS facility subject to

other conditions.

(d) The total net quota of number of cases

under the scheme that can be sanctioned is

capped at 152000 Nos.

5. Other conditions.— (a) The beneficiary

shall submit a life certificate every year only

in that respective month in which she

was sanctioned/started receiving the

disbursement/monthly installment under the

Griha Aadhar Scheme in the prescribed form

at such place identified by the department for

the purpose (Annexure–B). In case of a widow

who is a DSSS beneficiary and having a child,

the beneficiary shall also submit additionally

a life certificate in respect of such child every

year in that respective month in which she

was sanctioned/started receiving the

disbursement/monthly installment.

The period/month of submission prescribed

herein above will be extended upto a

maximum of 30 days but not more than 15 days

extension of period be granted from the date

of one year of completion of the sanction.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2428

Explanation.— In the event, the beneficiary

fails to file the Life Certificate as prescribed;

the monthly financial assistance sanctioned

shall be stopped forthwith. On receipt of the

Life Certificate, and subject to the fulfillment

of other conditions, prescribed from time to

time, the monthly financial assistance shall be

resumed prospectively from the next month

from the date of receipt of the Life Certificate.

(b) The beneficiary shall submit fresh

Income Certificate after a duration of three

years if the gross annual income is less than

Rs. 2,50,000/- only in that respective month,

in which she was sanctioned/started

receiving

the

disbursement/monthly

installment. In case the gross annual income

exceeds Rs. 2,50,000/- the beneficiary should

submit a fresh Income Certificate every year

only in that respective month, in which she

was sanctioned/started receiving the

disbursement/monthly installment under the

Griha Aadhar scheme at such place identified

by the department for the purpose. In the

event the beneficiary fails to produce the

Income Certificate as above, the monthly

financial assistance sanctioned shall be

stopped forthwith. On receipt of the Income

Certificate, and subject to the fulfillment of

other conditions, prescribed from time to time,

the financial assistance shall be resumed

prospectively from the next month from the

date of receipt of the Income Certificate.

The period/month of submission prescribed

herein above will be extended upto a

maximum of 30 days but not more than 15 days

extension of period be granted from the date

of one year of completion of the sanction.

Explanation.— In the event, the beneficiary

fails to produce the Income Certificate as

prescribed; the monthly financial assistance

sanctioned shall be stopped forthwith. On

receipt of the Income Certificate, and subject

to the fulfillment of other conditions,

prescribed from time to time, the financial

assistance shall be resumed prospectively

from the next month from the date of receipt

of the Income Certificate.

(a) In case the benefits under the scheme

are availed by the beneficiary based on

wrong/false information or declaration, an

action to prosecute shall be initiated and

person shall be debarred from getting the

benefits under any other schemes of the

Government.

(b) The Life Certificate stated in this

clause shall be signed by any Gazetted

Officer or MLA or MP in the Format at

Annexure-B.

case

elected

representatives, MLA/MP they may also

issue a consolidated Life Certificate under

one signature in relation to more than one

beneficiary covered in single declaration

form in the format at Annexure-F.

6. Power to remove difficulties.— (a) For the

purpose of removal of any difficulties in the

implementation of the Scheme, there shall be

a four member committee consisting of the

following:

(i) Secretary (Women and Child

Development) as Chairperson;

(ii) One Social Worker to be appointed by

the Government as Member;

(iii) Additional/Joint Secretary (Finance)

as Member; and

(iv) Director of Women and Child

Development as Member Secretary.

(b) The decision of the Committee shall be

final and binding on all concerned.

7. Power to relax.— The Government shall

have the power to amend, modify and cancel

any part or whole of the scheme at any time.

This notification is issued with the approval

of the Government vide U.O. No. 8688/F dated

10-10-2018.

By order and in the name of the Governor

of Goa.

Dipak Desai, Director & ex officio Joint

Secretary (W&CD).

Panaji, 26th December, 2018.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2429

Price Rs. 10/-

Serial No.

ANNEXURE – A

Application form for Financial Assistance under Griha Aadhar Scheme

To,

The Director,

Women and Child Development,

Government of Goa,

Panaji – Goa.

PART – I

1. Name of the applicant (in full) : ..........................................................................................................................................

2. Date of Birth (age) : ..................................................................................................................................................................

3. Residential address (in full) : ................................................................................................................................................

(Please attach proof)

House No. : ......................................................................................................................................................................................

Street/Road/Building name : ....................................................................................................................................................

Ward name/No. : ...........................................................................................................................................................................

City/Village : ..................................................................................................................................................................................

Constituency : ...............................................................................................................................................................................

Taluka : ............................................................................................................................................................................................

4. Details of family members : ...................................................................................................................................................

Sr. No. Name of the family members including the applicant

Relation

Occupation

Place of work, if any

5. Contact details of the applicant :

Phone : .............................................................................................

e-mail : .............................................................................................

6. Religion

: ..........................................................................................................

7. Category (Whether SC/ST/OBC/Others)

: .........................................................................................................

8. Ration card, if any (Please attach photocopy): .........................................................................................................

9. Aadhar card, if any (Please attach photocopy) : ......................................................................................................

10. Annual income (includes husband and wife,

taken together) (Please attach proof)

: .........................................................................................................

11. Bank Account Details (Please attach

photocopy of bank pass book)

: .........................................................................................................

Applicant’s

photo to be

attested by any

Gazetted Officer

or MLA or MP.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2430

Name of the Bank

: .........................................................................................................

Branch

: .........................................................................................................

Type of Account

: .........................................................................................................

Account No.

: ..........................................................................................................

IFSC code

: ..........................................................................................................

MICR code

: .........................................................................................................

12. Whether you or your spouse is a beneficiary

under Dayanand Social Security Scheme

: .........................................................................................................

13. Details of other scheme benefits availing,

if any

: .........................................................................................................

14. Marital Status

: Married/widow/divorced

DECLARATION

I, the undersigned .................................................... w/o ................................... do hereby declare that the information

given above is true and correct and nothing is false. That I shall be personally responsible for the correctness

of the information. I further declare that for wrong and false information, authorities may be at liberty to take

action, as deem fit against me, including filing criminal case.

Place : ................................... Date : ......................................

(Signature of the applicant)

PART - II

VERIFICATION

(To be signed by any Gazetted Officer or MLA or MP)

I, Shri/Smt. ............................................... do hereby certify that I personally know Smt. ................................

(applicant). I further certify that I have checked the particulars/information given in this application and

the same is found to be correct.

I recommend Smt. .................................................... (applicant) for grant of financial assistance under Griha

Aadhar Scheme as she fulfills all the conditions/criteria.

Signature : ............................................................................

...................................................................................

(Name in block letters)

Designation : ......................................................................

Address & : .........................................................................

Seal ...........................................................................

Telephone No. : ..................................................................

Place : ...................................................................................

Date : ....................................................................................

Note: The application shall be enclosed with the following documents:–

1. Self attested copy of Marriage certificate or any other documentary evidence as defined;

2. Self attested copy of 15 years Residence Certificate issued by Taluka Mamlatdar or Annexure C;

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2431

3. Proof of present residential address (includes a ration card; Election Photo Identity Card –EPIC or any

such document which establishes the present address.);

4. Attested copy of Ration card, if any;

5. Attested copy of Aadhar card, if any;

6. Income Certificate issued by the Competent Authority or Salary Certificate issued by the employer or

certificate and self-declaration as defined in Annexure-C & Annexure-E;

7. Attested copy of savings bank account pass book (with IFSC & MICR details); and

8. Birth certificate of the child along with life certificate as in Annexure B (in case of widow who is a DSSS

beneficiary).

ANNEXURE – B

Registration No./Sanction No./Aadhar Card No. ........................................... Mobile No. ...........................................

LIFE CERTIFICATE

(To be signed by any Gazetted Officer or MLA or MP )

Life Certificate of Applicant Life Certificate of Child (Tick whichever applicable/or both)

I, Shri/Smt. ............................................................... do hereby certify that I personally know Smt. ...................................,

w/o. ......................................, R/o. ..........................................................., the beneficiary of Griha Aadhar Scheme since

last .................................. years. I further certify that above said Smt. .......................................... is alive as on date.

* I further certify that Mast./Ms. ....................................................... is the son/daughter of the above said

Smt. ................................................., and that he/she is below eighteen years of age and is alive as on date

........................................................

Signature of the Beneficiary

(Name in block letters)

Designation : .....................................................

Seal

Address & : .......................................................

Telephone No. ................................................

Place : .....................................................

Date : ......................................................

* Strike out if not applicable.

ANNEXURE – C

CERTIFICATE OF RESIDENCE

(To be issued by a Gazetted Officer of the State Government)

I, Shri/Smt. ............................................................ do hereby certify that I personally know Smt.................................,

w/o.................................................., R/o. ............................................................................................, the applicant of

Griha Aadhar Scheme since last ............................................................. years.

I further certify that above said Smt. ......................................., is residing at ........................................, since the last

fifteen years.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2432

* I further certify that above said Smt. ..............................................., is working/self employed at ................................

/is a housewife/homemaker.

Signature : ..................................................................................

(Name in block letters)

Designation : ............................................................................

Address & : ............................................................................

seal

Telephone No. .........................................................................

Place : ..............................................

Date : ...............................................

* Strike out whatever is not applicable.

ANNEXURE-D

CERTIFICATE OF INCOME/SALARY

(to be issued by the employer on his letter head)

1. This is to certify that Ms./Mr. ............................................., is working in this ................................... (name of

organisation or unit or firm or establishment); as ..................................... since ............................... (date or month of

joining/since working).

2. This is to further certify that she/he has been paid a total gross salary (including all benefits and other

perquisites) amounting to; Rs. ................./- (in figures) (Rupees .................................... only) (in words) for the

financial year .................................... (indicate the appropriate financial year, being the financial year immediately

preceding the date of issue).

(A) Gross Salary :

Rs. ..............................................

(including the salary {basic pay, dearness allowance, HRA, conveyance allowance, etc.} and any other

allowance(s), fringe benefits and other perquisites granted).

(B)

Amount paid as Bonus/incentives :

Rs.

(C)

Amount paid as ex-Gratia :

Rs.

(D)

Total (A+B+C) :

Rs.

(E)

Contribution by the employer towards :

(a) EPF :

Rs.

(b) ESI scheme :

Rs.

(d) Superannuation :

Rs.

(e) Any other statutory deductions :

Rs.

3. This is to certify that the information provided above is as per this Office records.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2433

4. This certificate is issued as per the request of our employee for the purpose of availing the Griha Aadhar

Scheme of the Government of Goa.

Signature

Name of the Issuing Authority

Address & Seal

ANNEXURE - E

SELF DECLARATION OF OCCUPATION AND INCOME

(To be certified and attested before a Gazetted Officer of the State Government)

I, Smt. .......................................................... wife/daughter of .......................................... major of age, resident of

......................................................... do hereby solemnly declare as under:

1. I say and declare that, presently I am working/self-employed as ................................./not working/housewife/

/home-maker (strike out whichever not applicable), and my monthly salary/income is Rs. ................. (Rupees

........................................................ only).

2. I say and declare that my annual income from all sources does not exceed Rs. ............................ (Rupees

............................................... only).

(a) Income from agriculture sources :

Rs. ...............................................................

(b) Income from Bank deposits :

Rs. ...............................................................

(d) Income of husband (if applicable) :

Rs. ...............................................................

3. I say and declare that the present self-declaration is produced in the Office of Directorate of Women &

Child Development, Government of Goa, for availing the financial assistance under the GRIHA AADHAR

SCHEME.

4. I say and declare that the above contents are true to the best of my knowledge and nothing false has

been stated.

5. I say and declare that, in the event of any false declaration I shall be held responsible and shall be liable

for penal action as deemed fit against me including filing criminal case.

Solemnly declared at .................................... on this ......................................... day of the month of ...................... of

the year ...................................

(SIGNATURE OF THE DECLARANT)

Signed before me and attested:

Signature : ...................................................

Name & Designation of the Gazetted Officer : ...............

Address : .........................................

Seal

ANNEXURE-F

Consolidated Life Certificate Format for MLA/MP

Sr. No.

Name of the Griha Aadhar

Registration No./Sanctioned

Mobile No.

Signature of Beneficiary

Beneficiary

No./Aadhar Card No.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 40

3RD JANUARY, 2019

2434

10.

I, Shri/Smt. ......................................................................... do hereby certify that I personally know the above

mentioned beneficiaries of Griha Aadhar Scheme and I further certify that the above mentioned beneficiaries

are alive as on date.

(Name in block letters)

Name of the MP/MLA : ..................................................

Address & : .....................................................................

Seal

Place : ..............................

Date : ...............................

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