1225

Panaji, 22nd October, 2020 (Asvina 30, 1942)

SERIES I No. 30

Reg. No. G-2/RNP/GOA/32/2018-2020

RNI No. GOAENG/2002/6410

PUBLISHED BY AUTHORITY

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

NOTE

There is an Extraordinary issue to the Official Gazette, Series I No. 29 dated 15-10-2020, namely:—

(1) Extraordinary dated 15-10-2020 from pages 1223 to 1224 from Department of Law (Legal Affairs), Notification No.

8/11/2020-LA regarding the Goa Non-Biodegradable Garbage (Control) (Amendment) Ordinance, 2020.

INDEX

Department

Order/Notification

Subject

Pages

1.a. Animal Husbandry &

Not.- 13-91/Kamd/(S)/

Kamdhenu Scheme (Sudharit) Amended

1225

Veterinary Services

2020-21/4148

Dir. & ex officio Jt. Secy.

b. —do—

Corri.- 2-3(15)2020-21/4095

—

1226

Goa Legislature

Corri.- LA/Legn/2020/

—

1227

Secretariat

/1118/(Corri)

Secretary

3.a. Law

Not.- 10/6/2020-LA

The Farmers (Empowerment and Protection)

1227

Legal Affairs Division

Agreement on Price Assurance and Farm

Joint Secretary

Services Ordinance, 2020.

b. —do—

Not.- 10/6/2020-LA

The Banking Regulation (Amendment)

1239

Ordinance, 2020.

Revenue

Ord.- 14/59/2017-RD

Rates of services at CSC Bardez Taluka.

1244

Under Secretary

(Part-II)/7203

5.a. Women & Child Dev.

Not.- 2-279-LL-2012-

Laadli Laxmi Scheme.

1247

Dir. & ex officio Jt. Secy.

-DWCD/PART(I)/8327

b. —do—

Not.- 2-1232-GA/2019-20/

Griha Aadhar Scheme

1256

DWCD/8354

GOVERNMENT OF GOA

Department of Animal Husbandry &

Veterinary Services

Notification

13-91/Kamd/(S)/2020-21/4148

Read: (1) Kamdhenu Scheme (Sudharit)

notified vide Notification No. 13-91/

/Kamd/(S)/2012-13/4109

dated

05-11-2012 published in Official

Gazette, Series I No. 33 dated

15-11-2012.

(2) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2014-15/911 dated

27-05-2014 published in Official

Gazette, Series I No. 10 dated

05-06-2014.

(3) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2015-16/1563 dated

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1226

19-06-2015 published in Official

Gazette, Series I No. 13 dated

25-06-2015.

(4) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2015-16/3341 dated

02-09-2015 published in Official

Gazette, Series I No. 24 dated

10-09-2015.

(5) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2015-16/3539 dated

23-09-2015 published in Official

Gazette, Series I No. 27 dated

01-10-2015.

(6) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2016-17/2592 dated

05-08-2016 published in Official

Gazette, Series I No. 19 dated

11-08-2016.

(7) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2016-17/3405 dated

16-09-2016 published in Official

Gazette, Series I No. 25 dated

22-09-2016.

(8) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2018-19/121 dated

06-04-2018 published in Official

Gazette, Series I No. 3 dated

19-04-2018.

(9) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2018-19/2782 dated

26-07-2018 published in Official

Gazette, Series I No. 18 dated

02-08-2018.

(10) Kamdhenu Scheme (Sudharit)

amended vide Notification No. 13-

-91/Kamd/(S)/2019-20/2083 dated

09-07-2019 published in Official

Gazette, Series I No. 15 dated

11-07-2019.

KAMDHENU SCHEME (SUDHARIT)

AMENDED

Whereas the Government has notified the

Kamdhenu Scheme (Sudharit) Amended vide

Notification No. read at Sr. No. 1 above and

further amended vide Notification read at

Sr. No. 2, 3, 4, 5, 6, 7, 8, 9 and 10 above.

Whereas the above referred to Notifications

under

Kamdhenu

Scheme

(Sudharit)

Amended, after Clause (19) of the above

referred to Notifications, Clause (20) shall be

inserted as follows:

“(20) The Government may relax any of

the

clauses/conditions

deemed

necessary”.

By order and in the name of the Governor

of Goa.

Dr. Santosh V. Desai, Director & ex officio

Jt. Secretary (AH).

Panaji, 16th October, 2020.

——–––

Corrigendum

2-3(15)/2020-21/4095

Read: Goatery Scheme (Assistance for Goat

Rearing) notified vide Notification

No.

2-3(15)/2018-19/6795

dated

07-02-2019 published in Official

Gazette, Series I No. 46 dated 14th

February, 2019.

In partial modification of the above referred

Notification

the

Goatery

Scheme

(Assistance for Goat Rearing) Sr. No. 3 under

the eligiblity criteria viz. “Should have a Goat

Shed on height of approx 1.5 mts. from

ground admeasuring minimum 30 sq mts.

with flooring of bamboo/matti and roof of tiles/

/sheets/straw” stands deleted.

Rest all other contents in the Scheme

remains unaltered.

By order and in the name of the

Governor of Goa.

Dr. Santosh V. Dessai, Director & ex officio

Jt. Secretary (AH).

Panaji, 14th October, 2020.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1227

MINISTRY OF LAW AND JUSTICE

(Legislative Department)

New Delhi, the 5th June, 2020/Jyaishtha 15, 1942 (Saka)

Goa Legislature Secretariat

___

Corrigendum

LA/Legn/2020/1118/(Corri)

Read: Goa Legislature Secretariat Notification No. LA/Legn/2020/1005 dated 12-10-2020,

published in the Official Gazette, Series I No. 29 dated 15-10-2020.

In the Goa Legislature Notification No. LA/Legn/2020/1005 dated 12-10-2020, published in

the Official Gazette, Series 1 No. 29 dated 15-10-2020, for “By order and in the name of Governor

of Goa”, read “By order and in the name of the Speaker”.

By order and in the name of the Speaker,

Namrata Ulman, Secretary to the Goa Legislative Assembly.

Assembly Hall, Porvorim, 15th October, 2020.

———ttt———

Department of Law

Legal Affairs Division

Notification

10/6/2020-LA

The Farmers (Empowerment and Protection) Agreement on Price Assurance and Farm Services

Ordinance, 2020 (Ordinance No. 11 of 2020), which has been Promulgated by the President in

the Seventy-first Year of the Republic of India and published in the Gazette of India, Extraordinary,

Part II, Section 1, dated 5-6-2020, is hereby published for the general information of the public.

D. S. Raut Dessai, Joint Secretary (Law).

Porvorim, 16th July, 2020.

_______

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1244

RAM NATH KOVIND,

President.

————

DR. G. NARAYANA RAJU,

Secretary to the Govt. of India.

———ttt———

Department of Revenue

Order

14/59/2017-RD(Part-II)/7203

Read: Order No. 14/59/2017-RD dated

16-04-2018

Government of Goa has approved the

proposal of setting up the Citizen Services

Centre (CSC) at Bardez Taluka to deliver the

various Citizen Centric Services of various

Government Departments to the Citizens.

The Citizen Services Centre (CSC) will be

set up at Kadamba Bus Stand, Mapusa,

Bardez, Goa. The same shall be brought into

force w.e.f. 14-10-2020.

The applicant/people should therefore avail

this service through Citizen Services Centre

(CSC) only.

The details of services provided through

CSC with the prescribed rate are as

under:—

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1245

Sr. No.

Services

Fees

Every certified computerized copy of a serial number

Rs. 45/- for the first page and @

or entry in the record of rights, register of mutations

Rs. 15/- for every additional page.

and from the registers, accounts and records, other

than maps, maintained by a Talathi under section 8

of the Code.

Every certified copy of an entry in the register of property

Rs. 60/-

maintained by the City Survey Officer (Form D).

Every certified copy of a map of a survey number or of a

Rs. 150/- per Survey Number/

sub-division of a survey number or of any (uncoloured)

/Sub-Division Number.

map of any immoveable property prepared under

clause (a) of section 101 of the Code.

Every certified copy of a map of a survey number or of a

Rs. 150/- per Survey Number/

sub-division of a survey number or of an ordinary

/Sub-Division Number.

(uncoloured) map or plan of any immovable property

prepared under section 56 of the Code.

Every certified computerized copy of a map of a survey

Rs. 180/- per Survey Number/

number or of a sub-division of a survey number or of

/Sub-Division Number.

map or plan of any immovable property prepared under

section 56 of the Code.

Every certified copy of computerized map of a survey

Rs. 180/- per Survey Number/

number or of a sub-division of a survey number or of

/Sub-Division Number.

map or plan of any immovable property prepared under

section 56 of the Code with details of Form I appended

to the Goa, Daman and Diu Land Revenue (Records of

Rights and Register of Cultivators) Rules, 1969.

Every certified copy of a map or plan of a non-agricultural

Rs. 150/- per Survey Number/

survey number or a sub-division of such a survey number

/Sub-Division Number.

or of an extract of city survey prepared under section 65

of the Code.

Every certified computerized copy of a map or plan of a

Rs. 180/- per Survey Number/

non-agricultural survey number or a sub-division of

/Sub-Division Number.

such a survey number

Every certified computerized copy of full size copy of

Rs. 180/- for a Survey Number/

P. T. Sheet.

/Sub-Division Number and Rs. 80/-

for remaining each Survey

Number/Sub-Division Number.

10)

Every certified copy of following map or plan or certified

computerized copy of a map or a plan or of any portion of

map or plan (coloured copies with all details).

(a) detail Village map (As per the available scale)

Rs. 450/- for a copy upto 10 P.T.

Sheets and Rs. 100/- for each

additional P. T. Sheet with all

details.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1246

(b) Taluka map with Village boundary details

Rs. 1000/-

(As per the available scale)

Rs. 2000/-

(As per the available scale)

(d) Map of State of Goa (As per the available scale)

Rs. 2500/-

11)

Every certified copy of Form XV/Resurvey map under

Rs. 220/- per Survey Number/

section 65-A of the Code.

/Sub-Division Number.

12)

Every digitally signed copy of a map of survey number

Minimum of Rs. 220/- per

or of a Sub-Division of a survey number or plan of any

Survey Number/Sub-

immovable property prepared under section 56 of the

-Sub-Division Number.

Code with the details of Form I appended to the Goa,

Daman and Diu Land Revenue (Record of Rights and

13)

Every digitally signed copy of a map or plan of survey

Rs. 250/- per Survey Number/

number or a sub-division of a survey number prepared in

/Sub-Division Number.

Form J appended to the Goa, Daman and Diu Land Revenue

(City Survey) Rules, 1969 (Integrated Land Record).

14)

Every digitally signed copy of a map of a survey number

Minimum of Rs. 200/- per

or of a sub-division of a survey number or of a map or

Survey Number/Sub-

plan of any immovable property prepared under section

-Division Number.

56 of the Code.

Certificates

Sr. No.

Name of the e-services

Fees

Residence Certificate

50/-

Domicile Certificate

50/-

Mediclaim Certificate

50/-

Divergence Certificate

50/-

Caste Certificate

50/-

It is further informed that no services in the form of Certificate or the services which are

processed through e-district module will be issued from office of concerned Mamlatdar,

Dy. Collector and Collector & DSLR.

Isha M. Sawant, Under Secretary (Revenue-I)/Link.

Porvorim, 15th October, 2020.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1247

Department of Women & Child Development

Directorate of Women & Child Development

Notification

2-279-LL-2012-DWCD/PART (I)/8327

Read: 1. Notification No. 2/279/LL/2012/

DW&CD/2562 dated 06-07-2012 and

published in the Official Gazette

No. 16, Series I, dated 19-07-2012;

2. Amendment Notification No. 2/279/

LL/2012/DW&CD/2969

dated

07-08-2012 published in the Official

Gazette No. 19, Series I, dated

09-08-2012;

3. Amendment Notification No. 2/279/

LL/2012/DW&CD/0032

dated

02-01-2013 published in the Official

Gazette No. 44, Series I, dated

31-01-2013;

4. Amendment Notification No. 2/279/

LL/2012/DW&CD/4163

dated

22-04-2013 published in the Official

Gazette No. 4, Series I, dated

25-04-2013

5. Amendment Notification No. 2/279/

LL/2012/DW&CD/4231

dated

30-04-2013 and published in the

Official Gazette No. 6, Series I,

dated 09-05-2013

6. Amendment Notification No. 2/279/

/LL/2012/DW&CD/Part(I)/4780

dated 26-06-2013 and published in

the Official Gazette No. 13, Series I

dated 27-06-2013

7. Amendment Notification No. 2-277-

-LL-2015-DW&CD/(Part-I)/03835

dated 24-09-2015 and published in

the Official Gazette No. 28, Series I

dated 08-10-2015

8. Amendment Notification No. 2-279-

-LL-2012-DW&CD/(Part-I)/3401

dated 20-04-2016 and published in

the Official Gazette No. 4, Series I

dated 28-04-2016

9. Amendment Notification No. 2-279-

-LL-2012-DW&CD/Par t(I)/4057

dated 24-05-2016 and published in

the Official Gazette No. 9, Series I

dated 02-06-2016

10. Amendment Notification No. 2-279-

-LL-2012/DW&CD/Part(I)/7269

dated 02-11-2016 and published in

the Official Gazette No. 32, Series I

dated 10-11-2016

11. Amendment Notification No. 2-279-

-LL-2012/DW&CD/Part(I)/10382

dated 06-03-2019 and published in

the Official Gazette No. 50, Series I

dated 14-03-2019

12. Amendment Notification No. 2-279-

-LL-2012-DW&CD/Par t(I)/4920

dated 11-11-2019 and published in

the Official Gazette No. 33, Series I

dated 14-11-2019

In exercise of the powers conferred under

clause 6(3) of Laadli Laxmi Scheme notified

vide Notification No. 2/279/LL/2012/DW&CD/

2562 dated 06-07-2012 and published in the

Official Gazette No. 16, Series I, dated

19-07-2012, the Government hereby further

amends and publishes the said Scheme as

under:—

Objective of the Scheme:— The scheme

proposes to financially empower the girl child

to meet educational and other expenses on

becoming a major of age and to improve the

female sex ratio in the State.

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

scheme shall be called “Laadli Laxmi

Scheme”.

(2) The scheme shall come into force with

immediate effect.

II. Eligibility and other conditions.— (1)(A)

Any Girl who fulfils all of the following

conditions is eligible to apply:

(a) born in the State of Goa;

(b) resident of Goa for the last fifteen

years; and

is born in Goa and is also a resident of Goa

for the last fifteen years; or

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1248

(ii) whose one of the parents is residing

in Goa for last twenty five years.

(iii) whose parental income does not

exceed Rs. 3.00 lakhs per annum.

(B) Provided that a Girl, who is born outside

Goa, shall be eligible if she is:

(a) resident of Goa for the last fifteen

years;

(b) educated in Goa; for a minimum

period of 7 years (continuous); and

is born in Goa and is also a resident of Goa

for the last fifteen years; or

(ii) whose one of the parents is residing

in Goa for last twenty five years.

(iii) whose parental income does not

exceed Rs. 3.00 lakhs per annum.

(2) If any doubt arises regarding eligibility

of any, the same shall be decided by a

Committee consisting of the following:

(i) Secretary to Government of Goa in

charge of Department of Women and Child

Development as Chairperson,

(ii) One Social Worker to be appointed

by the Government as Member,

(iii) Additional/Joint Secretary to

Government of Goa in charge in the

Department of Finance as Member, and

(iv) Director, Directorate of Women and

Child Development as Member Secretary.

(3) The decision of the above Committee

shall be final and binding. No appeal or

request for reconsideration of decision shall

be allowed under the scheme.

(4) (a) All applications received from a girl

child who is an orphan or a destitute child or

who is born outside a legitimate wedlock or

an adopted girl child or any other case which

is covered under the objective of the scheme;

shall be referred to the Committee mentioned

above, if the application is made by the

guardians or the Institution/Organisations

which is taking care of the child.

(b) In case if an applicant is unable to

produce documents pertaining to parent’s

birth, residence, etc. on account of their

opposition to her marriage, such an

application shall be placed before the

Committee for decision.

has submitted all her documents required as

per the scheme but is unable to furnish her

parents documents due to death of both

parents, such an application shall be

sanctioned if the applicant submits her 15

years of residence certificate and birth

certificate along with death certificates of

both parents. Submission of parental income

certificate in case of such applicants shall be

waived off.

(5) The beneficiaries shall be grouped into

two categories, namely:—

(a) Those applicants who attain the age

of majority i.e. 18 years on or after

01-04-2012 (unmarried applicants), and

(b) Those who have already attained the

age of 18 years before 01-04-2012 and are

in the age group of 19 to 45 years (married

applicants) prospectively from 1st April,

2016.

(6) In case the applicant is an affected

person of Tillari Irrigation Project, which is a

joint venture of Government of Goa and

Government of Maharashtra and rehabilitated

in the State of Goa, her application shall be

sanctioned if she produces a certificate issued

by the Collector, North Goa District relaxing

the condition of 10/15 years domicile in the

State of Goa for various purposes for her

family.

III. Mode of operation.— (1) The unmarried

beneficiaries under the scheme shall be paid

Rs. 1.00 lakh as financial assistance, by means

of bank fixed deposit, jointly in the name of

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1249

the Director of Women and Child Development

and the applicant (the girl).

(2) The fixed deposit shall be renewed

annually automatically on maturity, along

with the amount of interest accrued, till the

date of claim by the applicant as per the

scheme or until the age of 45 years whichever

is earlier.

(3) The married beneficiaries under the

scheme shall be paid Rs. 1.00 lakh as financial

assistance, by means of cash payment.

For the purpose of operation of this scheme

through the bank/financial institution

concerned, the Government, shall execute a

Memorandum of Understanding (MoU),

detailing the terms and conditions of

operation of the bank account, the fixed

deposit account/certificate, amount of interest

accrued, authorization procedure for payment

to the beneficiary, terms of payment by the

Government to the bank/financial institution,

credit to the Government on closure of

individual account etc.

IV. Application procedure.— (1) The

applicant who attains the age of majority i.e.

18 years on or after 1st April 2012 [i.e. those

beneficiaries covered under clause 2(5)(a)

above] may apply to the Director of Women

and Child Development, Panaji-Goa, in the

prescribed form (“Annexure I” to this

scheme), complete in all respects, along with

two passport size photographs and the

following documents:

(i) Attested copy of the Birth Certificate

of the applicant.

(ii) Attested copy of any document as a

proof of 15 years residence of the applicant

in the State of Goa. In lieu of the Residence

Certificate, the previous School Leaving

Certificate and the current Bonafide

Student Certificate issued by the

recognized Educational Institution in

which the girl is presently studying can

also be produced. However, in case of girls

who discontinued education at school level,

the gap period i.e., from the time of

discontinuation of education till completion

of 18 years of age/marriage as the case

may be, may be proved by production of

residence certificate. In case of graduates,

the Certificates of passing of Xth, XIIth and

Graduation is adequate evidence.

(iii) 15 years or 25 years Residence

Certificate of the parent(s) as the case may

be. In lieu of the Residence Certificate, any

documentary evidence to prove the

residence for the specified period can also

be produced which may include:

(a) The land records i.e. tenancy rights,

mundcarial rights, occupancy rights, etc;

(b) Employment certificate; or

of the Committee.

(d) In case of a girl whose father/

mother is in service either with the State

Government or the Central Government

or the public sector undertakings, in lieu

of the certificate of residence such

applicant may produce the service

certificate of 25 years issued by the Head

of the Department. However, the girl

should be born in Goa and should have

studied in Goa up to Xth class.

(iv) Birth Certificate of the parent(s). If

no birth certificate is available one of the

following documents can be produced

showing the details namely the date and

place of Birth of the parent(s):

(a) Baptism certificate;

(b) School leaving certificate of the

parent(s) etc;

that one of the grandparents of the girl

has lived in Goa around the time of the

date of birth claimed by the parent(s);

(d)

Any

such

records,

which

establishes the date of birth of the

parent(s).

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1250

(v) Attested copy of the Aadhar card if

any, and

(vi) A Self-Declaration in the format as

given in “Annexure II” to this scheme.

(vii) Annual Income Certificate of parents

of the immediate previous financial year at

the time of submission of application, issued

by the Competent Authority. The Income

Certificate shall include the annual income

of the mother and father of the applicant

taken together and not the income of the

family.

Note 1: The Aadhar card will be compulsory

for all applicants after 01-04-2013. However, the

Government by separate Order may relax the

requirement of producing the Aadhar card and

such other certificate(s), for a further period of

time, as may be prescribed in the said Order.

Note 2: The application form (Annexure-I) shall

be serially numbered and issued by the

designated Offices notified by the Director of

Women and Child Development/designated

branches of the bank concerned. Application

forms in any other format or proforma or

reprographic copies of the same shall not be

accepted.

Note 3: The application form (Annexure-I) shall

be signed by the applicant in the presence of

either the Member of Legislative Assembly, the

Member of Parliament, Government Officer (not

below the rank of Additional/Special Secretary

to the Government of Goa) or the District

Magistrate.

(2) In case of those beneficiaries who have

already attained the age of 18 and above

before 01-04-2012 [i.e. those beneficiaries

covered under clause 2(5)(b) above] and have

got/are getting married hereinafter, may

apply to the Director of Women and Child

Development, Panaji-Goa, in the prescribed

form, in “Annexure-I” of this scheme with all

the documents listed in clause 4 (1)

above along with following additional

documents;

(i) Attested copy of the Civil Marriage

Registration Certificate (which may also

include the first registration certificate)

provided the certificate is dated on or after

01-04-2012 only.

(3) The application shall be submitted

within one year, from the date of attaining

the age of 18 years or from the date of Civil

Marriage Registration. All applications

received beyond the specified period of one

year shall be rejected.

(4) The application duly filled and complete

in all respect, received by the Directorate of

Women and Child Development, shall be

scrutinized and sanctioned by the Director of

Women and Child Development, in the

chronological order in which application is

received in his Office.

(5) The applicant shall have to open an

account in the bank/financial institution as

declared by the Government, in any of its

branches in the State of Goa.

(6) In order to receive the money after civil

marriage, the beneficiary shall personally

present herself before the designated

officer(s) or the Director of the Directorate,

Women and Child Development for issue of

withdrawal order/letter, which in turn can

be presented in the bank/financial institution

for withdrawal of the money/amount due and

payable. The withdrawal order/letter shall be

issued based on the submission of the Civil

Marriage Registration Certificate (which may

also include the first registration certificate).

(7) If the girl who has been sanctioned the

benefits under the scheme, intends to

withdraw the said amount for her use in

business/profession or for her further studies,

should apply in the prescribed Form ‘A’ duly

completed in all respects alongwith the

relevant

documents

directly

the

Department such cases shall be placed

before the Committee for decision.

V. Other Conditions.— (1) (a) In the event

of death of the beneficiary before the

marriage, the amount in the fixed deposit shall

be paid by the bank/financial institution

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1251

concerned to the Director of Women & Child

Development, who shall deposit the same into

an appropriate Government account.

(b) In the event of death of the beneficiary

after marriage before claiming the benefit,

the financial assistance shall be released to

the parents. If both the parents of the

beneficiary are expired, the assistance shall

be released to the guardian whose name is

mentioned in the Laadli Laxmi application of

the expired beneficiary.

(2) A separate account shall be opened

with one of the bank/financial institution

concerned to be identified by the Government

for implementation of the scheme, which shall

prepare a fixed deposit in the name of the

applicant as per the sanction order issued by

the Director, Women and Child Development,

from time to time.

(3) The money under the fixed deposit shall

be permitted to be withdrawn from the bank/

financial institution, provided the beneficiary

produces the withdrawal order/letter from the

Director, Women and Child Development or

any other authorised official and also

personally present herself before the bank

officials.

(4) The benefits under the scheme shall be

given only once in the lifetime of each

beneficiary.

(5) The unpaid money under the fixed

deposit shall be credited back to the

Government along with the interest accrued

thereon and no family members/co-signatory/

guardian, as the case may be shall have right/

claim of whatsoever on the same.

(6) In the event, there is no claim by the

beneficiary till attaining the age of 45 years,

the fixed deposit shall be closed and the

amount shall be credited back to the

Government along with the interest accrued

thereon. No further assistance of any nature

shall be provided to the concerned.

(7) This scheme does not confer any right

on any one merely on application made

under the scheme, for claiming the benefits

under this scheme and denial of the benefits

under the scheme, after the same has been

examined by the Director of Women and Child

Development as well as the Committee

constituted under clause 2(2) above, shall not

be disputed.

(8) The disbursement of benefits under this

scheme shall be subject to the availability of

funds provided for the purpose annually by

means of budgetary support.

(9) Any person who avails financial

assistance under the scheme on the basis of

false information, submitting false declaration

or by concealing material information, shall

liable

for

criminal

prosecution.

Notwithstanding any criminal prosecution

that may be initiated or result thereof, such

person shall also be debarred for life for

getting any benefits and or assistance under

any other schemes of the Government.

VI. Power to relax.— (1) For removal of

any difficulties in the implementation of the

scheme, there shall be a four member

Committee constituted as in clause 2(2)

above.

(2) The decision of the Committee shall be

final and binding on all concerned.

(3) The Government shall have the power

to amend, modify and cancel any part or

whole of the scheme at any time.

This notification shall come into force with

effect from the date of publication of this

notification in the Official Gazette.

This issues with approval of the

Government vide U.O. No. 288/F dated

06-10-2020 and concurrence of Finance

(Expenditure) Department vide U. O.

No. 1400068894 dated 08-08-2020.

By order and in the name of the Governor

of Goa

Umeshchandra Joshi, Director & ex officio

Joint

Secretary

(Women

Child

Development).

Panaji, 14th October, 2020.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1252

Price: Rs. 100/-

Sr. No.

Annexure – I (Bank Copy)

Application Form for ‘LAADLI LAXMI’ Scheme.

PART I

1. *Name of the applicant (Girl):_________________________________________

(As specified on birth certificate) (Surname) (Name) (Middle Name)

2. *Applicant’s Date of Birth:

(dd/mm/yyyy)

3. *Name of the Applicant’s

(i) Mother:________________________________________

(ii) Father:_________________________________________

(iii) Guardian:_____________________________________

4. *Married: Yes

5. *Residential address (in full):

House No.: ___________________________________ Ward No. _________________________________

Street/Bldg. Name:_____________________________________________ City/Village: _______________

Constituency : ________________________________ Taluka : _______________ District :___________

Post Office : ___________________________________ Pin Code : _________________________________

6. *Contact details:

(i) Landline: ______________________________________

(ii) Mobile: _______________________________________

(iii) e-mail: ________________________________________

7. *Religion:

Hindu

Muslim

Christian

Others

8. Category:

OBC

Others

9. *Aadhar Card No.:

10. EPIC number (if any):

11. Annual Parental Income: _________________________________________________________________

DECLARATION

I, the undersigned, hereby declare that the information given above is true and correct, and nothing

stated is false and I have not been benefited with this scheme earlier. I shall be personally responsible for

any false and incorrect information/documents, for which the authorities shall be at liberty to take penal

action as deem fit against me including filing criminal case.

Dated:

(Name & Signature of the Applicant)

Signed in presence of:

Signature, Name & Seal of

Member of Legislative Assembly/Member of Parliament, Government Officers, not below the rank of

Additional/Special Secretaries to the Government of Goa and the District Magistrates.

Note: Fields marked in * are compulsory

Passport size Photograph

of the applicant,

countersigned by the

MLA or MP Government

Officers, not below the

rank of Additional/

Special Secretaries to

the Government of Goa

and the District

Magistrates.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1253

FOR OFFICE USE ONLY

Authorisation to the Bank

Date : …………………………..

To,

The Branch Manager/Authorised Officer of

_______________________________________________________________________________ (Name of Bank)

Sir/Madam,

Your are authorised to release an amount of Rs. 1,00,000/- to Ms. ___________________

___________________________________________ whose details have been verified, in the form of cash

payment/fixed deposit receipt.

______________________________

Director

Directorate of Women & Child Development

_________

Price: Rs. 100/- Sr. No.

Annexure – I (Office Copy)

Application Form for ‘LAADLI LAXMI’ Scheme

PART I

1. *Name of the applicant (Girl):_____________________________________________

(As specified on birth certificate) (Surname) (Name) (Middle Name)

2. *Applicant’s Date of Birth:

(dd/mm/yyyy)

3. *Name of the Applicant’s

(i) Mother:________________________________________

(iii) Father:_________________________________________

(iv) Guardian:______________________________________

4. *Married:

Yes

5. *Residential address (in full):

House No.: _______________________________ Ward No. _____________________________________

Street/Bldg. Name:_____________________________________________ City/Village: _______________

Constituency : ______________________________ Taluka : _____________ District :___________

Post Office : _____________________________ Pin Code : _________________________________

6. *Contact details:

(i) Landline: ______________________________________

(ii) Mobile: _______________________________________

(iii) e-mail: ________________________________________

7. *Religion:

Hindu

Muslim

Christian

Others

8. Category:

OBC

Others

9. *Aadhar Card No.:

10. EPIC number (if any):

11. Annual Parental Income: _____________________________________________________________

Passport size Photograph

of the applicant,

countersigned by the

MLA or MP Government

Officers, not below the

rank of Additional/

Special Secretaries to

the Government of Goa

and the District

Magistrates.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1254

DECLARATION

I, the undersigned, hereby declare that the information given above is true and correct, and nothing

stated is false and I have not been benefited with this scheme earlier. I shall be personally responsible for

any false and incorrect information/documents, for which the authorities shall be at liberty to take penal

action as deem fit against me including filing criminal case.

Dated:

(Name & Signature of the Applicant)

Signed in presence of:

Signature, Name & Seal of

Member of Legislative Assembly/Member of Parliament, Government Officers, not below the rank of

Additional/Special Secretaries to the Government of Goa and the District Magistrates.

Note: Fields marked in * are compulsory.

PART II

The application shall be enclosed with the following documents:—

1. Self Certified copy of Birth Certificate of the applicant.

2. Residence Certificate of the applicant. In lieu of the Residence Certificate, the previous School

Leaving Certificate and the current Bonafide Student Certificate issued by the recognized

Educational Institution in which the Girl is presently studying can also be produced. However, in

case of girls who discontinued education at school level, the gap period i.e. from the time of

discontinuation of education till completion of 18 years of age/marriage as the case may be proved

by production of residence certificate. In case of graduates, the certificates of passing of Xth, XIIth

and Graduation is adequate evidence.

3. Self Certified copy of Aadhar Card.

4. Self Certified copy of the Civil Marriage Registration Certificate, which may also include the first

registration certificate.

5. Self Certified copy of 15 years or 25 years Residence Certificate of one of the parent(s) of the

applicant as the case may be. In lieu of the Residence Certificate, any documentary evidence to

prove the residence for the specified period can also be produced which may include:

i. the land records i.e. tenancy rights; mundcarial rights; occupancy rights, etc;

ii. Employment certificate; or

iii. Any such records to the satisfaction of the Committee.

6. Self Certified copy of Birth Certificate of one of the parent(s) of the applicant as the case may be:

If no birth certificate is available, one of the following documents can be produced showing the

details namely the date and place of Birth of the parent(s):

i. Baptism certificate;

ii. School leaving certificate of the parent(s);

iii. Any document which establishes that one of the grandparents of the girl have lived in Goa

around the time of the date of birth claimed by the parent(s); or

iv. Any such records, which establishes the date of birth of the parent(s).

7. Self-Declaration of the applicant.

8. Pre-receipt with revenue stamp (in duplicate) as prescribed.

9. Annual Income Certificate of parents issued by the Competent Authority.

Note:

1. The Application shall be submitted within one year, from the date of attaining the age of 18 years or

from the date of Civil Marriage Registration. All applications received beyond the specified period of one

year shall be rejected.

2. Applicants shall attach their recent passport size photograph only, Edited photographs shall not be

attached.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1255

Annexure – II

(Fill in the blanks and strike out whichever is not applicable)

SELF-DECLARATION

I, ________________________________________________________________________ daughter of

Shri___________________________________________ aged ______________ years, Indian National, resident

of ——————————————————————————— do hereby state and declare as under:

1. That I have applied for financial assistance under the Laadli Laxmi Scheme.

2. That I am born at _____________________, State_________________ on ______________

3. That I have completed 18 years of age as on ______________________________ and that I am not above

45 years of age.

4. That I belong to ______________________ religion.

5. That I belong to SC/ST/OBC/OTHERS category.

6. That I have been residing at the above notified address for last _____________________ years and that

I am resident of Goa for the last ______________ years.

7. That my mother, _______________________ (name of mother) aged _________ years is born in Goa/

outside Goa and is also the resident of Goa for the last ______ years and is alive till date/died on ______

8. That my father,___________________________ (name of father) aged ________ years is born in Goa/

outside Goa and is also resident of Goa for last________ and is alive till date/died on______________.

9. (a) That I have studied/studying in Goa from Std. ________________ to ______________ for the period

from ____________ to __________ (till date) for ___________years.

(b) That I am working/unemployed/self employed in Goa for the period from ______ to _________ for

____________ years.

10. That my mother is working/self employed/retired/pensioner/unemployed at ____________________

_______________________ _____________ (name and address of the Organization) having annual

income of Rs. ____________/-.

11. That my father is working/self employed/retired/pensioner/unemployed at_____________________

________________________ ________ (name and address of the Organization) having annual

income of Rs. _________________/-.

12. That apart from the above my parents do not have any other source of income.

13. That my annual parental income is Rs. ______________________________ /- per annum and does

not exceed Rs. 8,00,000/- per annum.

14. That the information given above is true and correct, and nothing stated is false and I shall be

responsible for correctness of the information.”

Declared on this ———-th day of month of ———————of the year—————

____________________________

DECLARANT

_________

Consent for Authentication

I, the holder of Aadhaar number _______________________, hereby give my consent to Directorate

of Women & Child Development to obtain my Aadhaar number, Name and Fingerprint/Iris for authentication

with UIDAI. Directorate of Women & Child Development has informed me that my identity information

would only be used for Laadli Laxmi Scheme and also informed that my biometrics will not be stored/shared

Passport size

signed

Photograph

of the

Applicant

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1256

and will be submitted to Central Identities Data Repository only for the purpose of authentication.

(Signature of the Aadhaar Number Holder/I agree)

________

Sr. No.

PRE-RECEIPT

Received with thanks from Director of Women and Child Development, Panaji a sum of Rs. 1,00,000/-

(Rupees one lakh only) in the form of Fixed Deposit Receipt (FDR)/Cash towards financial assistance under

Laadli Laxmi Scheme.

Date :

Name: __________________________________________

Place:

Address: ______________________________________

______________________________________

________

Sr. No.

PRE-RECEIPT

Received with thanks from Director of Women and Child Development, Panaji a sum of Rs. 1,00,000/-

(Rupees one lakh only) in the form of Fixed Deposit Receipt (FDR)/Cash towards financial assistance under

Laadli Laxmi Scheme.

Date :

Name: __________________________________________

Place:

Address: ______________________________________

______________________________________

_________

Notification

2-1232-GA/2019-20/DWCD/8354

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

(10) Amendment Notification No. 2-

280-SL-2012-DWCD/8666 dated

26-12-2018

(11) Amendment Notification No. 2-

1232-GA/2019-20/DWCD/7037

dated 31-01-2020

Affix

Re. 1/-

Revenue

stamp

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1257

GRIHA AADHAR SCHEME

In exercise of the powers conferred under

clause 7 of Griha Aadhar Scheme notified vide

Notification No. 2-280-SL-2012-DW&CD/4291

dated 01-10-2012 and published in the Official

Gazette No. 27, Series I, dated 04-10-2012,

the Government hereby further amends and

publishes the said Scheme as under:-

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.

to those married woman who or whose

husband 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

Directorate

Social

Welfare,

Government of Goa shall be eligible for

benefit under this scheme. On completion

of 18 years of the child, she shall be entitled

to receive the benefits of any one of the

above schemes.

Note 1: The term ‘married woman’ includes a

widow and a divorcee. In such cases also 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 issued by the

competent authority. In case of non-

availability of Marriage Certificate, Birth

Certificate of the child indicating the name

of the beneficiary as the mother may be

considered. All such cases shall be referred

to the Committee constituted in terms of

clause 6 (a) for decision. However, Marriage

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1258

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 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.

Provided that in case of a married women

who is originally native from outside the

State and has married to a person of Goan

origin residing in Goa for at least 15 years

provided they are settled in Goa for a period

of one year, along with her birth certificate

as a proof that she is native of outside Goa,

birth certificate and 15 years Residence

Certificate of her husband.

(v) Income Certificate issued by the

Competent authority (i.e. Secretary, Village

Panchayat/Chief

Officer,

Municipal

Council). Alongwith this applicant should

submit a self-declaration in form 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/- and

also that the applicant or her husband is

not employed in any of the entities on

regular basis as mentioned in Clause 2. (c).

This self-declaration need not be notarized.

(vi) Self attested copy of savings bank

account pass book (with IFSC and MICR

details). The bank account submitted

should be preferably Aadhar linked for DBT

(Direct Benefit Transfer) purpose.

(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.

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 ABPS (Aadhar Bridge

Payment System)/ACH (Automated Credit

House)/NEFT (National Electronic Fund

Transfer) 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 alongwith an

income certificate issued by the Competent

authority (i.e. Secretary, Village Panchayat/

Chief Officer, Municipal Council) every year,

only in that respective month in which she

was sanctioned the benefits 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 the benefits under

the Griha Aadhar Scheme. The period/month

of submission prescribed herein above will

be extended upto a maximum of one month.

(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.

the Life Certificate alongwith Income

Certificate as prescribed; the monthly

financial assistance sanctioned shall be

stopped forthwith. On receipt of the Life

Certificate and Income 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 and

Income Certificate.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1259

(d) In case of non-withdrawal of financial assistance received by the beneficiary under the

scheme for a continuous period of 6 months and above, then the accumulated amount shall

be reversed in the form of Demand Draft in favour of Director, Directorate of Women & Child

Development by the concerned bank.

(e) 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.

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. 307/F dated

14-10-2020.

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

Umeshchandra Joshi, Director & ex officio Joint Secretary (Women & Child Development).

Panaji, 14th October, 2020.

________

Price Rs. 50/-

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)

_____________________________________________

(Surname)

(Name) (Middle Name)

2. Date of Birth (age)

_____________________________________________

3. Residential address(in full)

_____________________________________________

(Please attach proof)

House No.

_____________________________________________

Street/Road/Building name

_____________________________________________

Applicant’s

photo to be

attested by any

Gazetted

Officer or MLA

or MP.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1260

Ward name/No.

_____________________________________________

City/Village

_____________________________________________

Constituency

_____________________________________________

Taluka

_____________________________________________

4. Details of family members

Sr.

Name of the family members

Relation

Occupation

Place of work

No.

including the applicant

if any

5. Contact details of the applicant

Contact No. : __________________________________

e-mail : _______________________________________

6. Religion

_____________________________________________

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

_____________________________________________

8. EPIC No. (Please attach photocopy)

_____________________________________________

9. Aadhar Card No. (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)

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

15. Date of Birth & Age of the minor child,

_____________________________________________

if any (in case of widow availing DSSS)

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 and I shall be

debarred from receiving the benefit from any other Government Scheme.

Place:_____________

(Signature of the applicant)

Date: _____________

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1261

PART - II

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 husband is presently working/self-employed as _______________ /not

working (strike out whichever not applicable), and my monthly salary/income is Rs. _________

(Rupees ___________________ ___________________only).

3. I say and declare that me and my husband are not employed in any of the following entities on

regular basis.

(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).

4. 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. _________________.

5. 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.

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

has been stated.

7. 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

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1262

PART - III

CONSENT FOR AUTHENTICATION

I, the holder of Aadhaar number _______________________, hereby give my consent to Directorate of

Women & Child Development to obtain my Aadhaar number, Name and Fingerprint/Iris for authentication

with UIDAI. Directorate of Women & Child Development has informed me that my identity information

would only be used for Griha Aadhar Scheme and also informed that my biometrics will not be stored/

shared and will be submitted to Central Identities Data Repository only for the purpose of authentication.

(Signature of the Aadhaar Number Holder/I agree)

________

PART - IV

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: ___________

__________

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.

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 30

22ND OCTOBER, 2020

1263

* 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

NOTE: The application shall be enclosed with the following documents:

1. Self attested copy of Marriage certificate issued by the competent authority;

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

3. Proof of present residential address (includes Election Photo Identity Card–EPIC or any such document which

establishes the present address);

4. Attested copy of Birth certificate alongwith one year residence certificate of the applicant and Birth certificate

alongwith 15 years Residence certificate of her husband (in case of applicant who is originally native from

outside the State and has married to a person of Goan origin);

5. Attested copy of Aadhar card;

6. Income Certificate issued by the Competent authority (i.e. Secretary, Village Panchayat/Chief Officer, Municipal

Council);

7. Attested copy of savings bank account pass book with IFSC & MICR details (The bank account submitted

should be preferably Aadhar linked for DBT (Direct Benefit Transfer) purpose.), and;

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

beneficiary).

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