RNI No. GOAENG/2002/6410 Reg. No. RNP/GOA/32/2021-2023
Panaji, 14th January, 2021 (Pausa 24, 1942) SERIES I No. 42 PUBLISHED BY AUTHORITY
NOTES
There is an Extraordinary issue to the Official Gazette, Series I No. 41 dated 7-1-2021, namely:—
(1) Extraordinary dated 11-1-2021 from pages 1773 to 1774, Department of Power, Notification No. CEE/Accts/357/ OTS/2020-21/69/3315 dated 8-1-2021 regarding extension of validity of OTS Scheme, 2020.
INDEX
Department Order/Notification/Add. Subject Pages
1. Environment & Climate Corri.- 5/20/87-STE/DIR/ — 1775 Change /Part VII/1138 Dir. & ex officio Jt. Secy.
2. GAD Not.- 23/1/87-GA&C The Business of the Government of Goa (Allocation) 1778 Under Secretary (Vol.IV)/2593 (Thirty-eighth Amendment) Rules, 2020.
3. River Navigation Not.- RND/Accts/Toll Fee/ Fixation of rates of special trips for Ferry boats. 1778 Captain & ex off. Jt. Secy. 2020-2021/1641
4. Science & Technology & Add.- 227-10-2016/STE- — 1779 Waste Management DIR/965 Dir. & ex officio Jt. Secy.
5. Transport Not.- D.Tpt/Accts/TRANS/ The Goa State Interim Compensation to road 1780 Dir. & ex officio Addl. Secy. /2021/54 Accident Victims, 2020 Scheme.
GOVERNMENT OF GOA
(2) Notification No. 5/20/87-STE/DIR/
Part VII/1030 dated 11th December,
2020 published in Official Gazette,
Series I No. 40 dated 31-12-2020.
Department of Environment & Climate Change __
Corrigendum
In exercise of the powers conferred by sub- -section 3(A) of section 12 of the Water 5/20/87-STE/DIR/Part VII/1138
(Prevention and Control of Pollution) Act, 1974
(Central Act 6 of 1974); and in supersession Read: (1) Notification No. 5/20/87-STE/DIR/
of notification No. 5/20/87-STE/DIR/Part VII/ Part VII/591 dated 09th September,
1030 dated 11-12-2020 read at 2 above, the 2020 published in Official Gazette,
Series I No. 25 dated 17-09-2020. Goa State Pollution Control Board (GSPCB), OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 2021 with the approval of the Government of Goa; hereby makes the following amendment rules so as to regulate the recruitment to various technical and non technical posts in the Goa State Pollution Control Board, namely:—
1. Short title, application and commence- ment.— (i) These rules may be called the Goa State Pollution Control Board, Group 'A', 'B', 'C' and 'D' posts, Recruitment (Amendment) Rules, 2020 (hereinafter referred to as 'these rules').
(iii) they shall come into force from the date
of their publication in the Official Gazette.
2. Amendment to Schedule to the Goa State Pollution Control Board, Group 'A', 'B', 'C' and 'D' posts, Recruitment Rules, 2020.— (1) In Serial No. 2 in column No. 12, the existing expression "Promotion of Assistant Environmental Engineer for the Board with atleast 5 years service in the grade/holding analogous position for at least 5 years in the grade", shall be substituted by new expression "Promotion of Assistant Environmental Engineer of the Board with atleast 5 years service in the grade/holding analogous position/for at least 5 years in the grade. OR Masters Degree in Environmental Engineering/Public Health Engineering from a recognized University/Institution having experience of atleast 3 years in pollution control or in related subject".
(2) In Serial No. 3 in column No. 8, the existing expression "Degree in Civil Engineering/Mechanical Engineering/ Environmental Engineering or equivalent from a recognised University/Institution and experience in pollution control or related subjects. (2) Atleast 7 years experience in pollution control or related subject. Knowledge of Konkani. Desirable: (1) M. Tech in Environmental Engineering (2) Knowledge of Marathi" shall be substituted with new expression "N. A."
(3) In Serial No. 4 in column No. 8, the existing expression "Essential: (1) Degree in Engineering (Civil)/Mechanical/Environment from a recognised University/Institution.
(2) At least four years working expenrience in industrial pollution control measures and knowledge of Environmental Rules and Acts in a Government undertaking, registered societies/or in any other reputed organisation. (3) Knowledge of Konkani (4) M. Tech in Environmental Engineering, Desirable: (1) Knowledge of Marathi." shall be substituted with new expression "Essential: (1) Degree in Engineering (Chemical/Civil)/Mechanical/ Environment from a recognised University/ Institution. (2) At least Four years working experience in industrial pollution control measures and knowledge of Environmental Rules and Acts in a Government undertaking, registered societies/or in any other reputed organisation. (3) Knowledge of Konkani Desirable.: (1) Knowledge of Marathi (2) M. Tech in Environmental Engineering."
(4) In Serial No. 5 in column 3 the expression "(04) four" shall be substituted with new expression "(03) Three".
(5) In Serial No. 7 in column 7 and 8, the existing expression "Not exceeding 40 years (relaxable for Government servants/working in Government institutions/recognised Government undertaking/Registered Societies upto 5 years)" and "Essential: (1) Masters Degree in Chemistry/any branch of Environmental Science from a recognised University/Institution with at least 12 years experience in pollution control or related field in Government organisation or in other reputed Organisation/Institution OR Doctorate in any of the above subjects and possessing at least 12 years experience in pollution control or related field in a Government or in any other reputed organisation. (2) Knowledge of Konkani Desirable: Knowledge of Marathi" shall be substituted with the expression "N.A.".
(6) In Serial No. 8. for column 11, for the expression "By promotion" shall be substituted with the expression "Promotion of Scientist 'B' with atleast 5 years experience.".
(7) In Serial No. 11 in column 11, for the expression "By promotion failing which by OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 2021 direct recruitment" shall be substituted with the expression "70% by promotion failing which by direct recruitment and 30% by direct recruitment failing which by transfer on deputation".
(8) In Serial No. 15 in column 3, the expression "6 (Six)" shall be substituted with expression "7 (Seven)".
(9) In Serial No. 16 in column 4, the expression "Group 'D'" shall be substituted with expression "Group 'C'".
(10) In Serial No. 16 in column 5, the existing expression "Rs. 5200-20200+1400" shall be substituted with the expression "Rs. 5200-20200+1800".
(11) In Serial No. 16 in column 8, the existing expression "Essential: (1) VIIIth std. Pass (2) Knowledge of Konkani, Desirable: (1) Knowledge of Marathi" shall be substituted with the expression "Essential: (1) Passed Secondary School Certificate/Examination from a recognised Board/Institution. (2) Knowledge of Konkani. Desirable: (1) Knowledge of Marathi (2) Basic Knowledge of handling chemicals/glassware (3) Multitasking skills such as knowledge of operating office machines including computers".
(12) In Serial No. 17 in column 8, the expression "Essential: (1) Bachelors Degree in Law from a recognised University (2) At least 10 years working experience in Legal Department of Govt./Govt. undertaking/ /Institution/Autonomous Body dealing with Environment Acts (3) Knowledge of Konkani Desirable: (1) Knowledge of Marathi" shall be substituted with the expression "Essential: (1) Bachelors Degree in Law from a recognised University (2) At least 8 years working experience in Legal Department of Govt./Govt. undertaking/Institution/Autonomous Body dealing with Environment Acts (3) Knowledge of Konkani, Desirable: (1) Knowledge of Marathi".
(13) In Serial No. 18 in column 8, the expression "Essential: 1) Bachelors Degree in Law from a recognised University 2) at least 5 years working experience in Legal Department of Govt. undertaking/Institution /Autonomous Body dealing with Environment Acts. (3) Knowledge of Konkani" shall be substituted with the expression "Essential: (1) Bachelors Degree in Law from a recognised University (2) At least 8 years working experience in Legal Department of Govt./Govt. undertaking/Institution/ Autonomous Body dealing with Environment Acts. (3) Knowledge of Konkani".
(14) In Serial No. 20 in column 9, the expression "N.A." shall be substituted with the expression "Age No. Qualifications: To the extent indicated in column No. 12.
(15) In Serial No. 21 in column 12, the expression "By promotion of Network Assistant of the Board with 5 years of service in the grade and possessing the qualifications as at column No. 8" shall be substituted with the expression "By promotion of Network Assistant of the Board with 5 years of service in the grade".
(16) In Serial No. 22 in column 5, the expression "Rs. 5200-20200+1900" shall be substituted with the expression "Rs. 5200- 20200-2400".
(17) In Serial No. 22 in column 9, the expression "N.A." shall be substituted with the expression "Age No. Qualifications: To the extent indicated in column No. 12".
(18) In Serial No. 24 in column 9 the expression "Age: No. Qualification: To the extent indicated in column No. 12" shall be substituted with the expression "N.A.".
(19) In Serial No. 34 in column 8 the expression "Essential: (1) Middle School or equivalent qualifications" shall be substituted with the expression "Essential: (1) Passed Secondary School Certificate/Examination from a recognised Board/Institution."
(20) In Serial No. 35 in column 3, the expression "7 (Seven)" shall be substituted with the expression "8 (Eight)".
(21) In Serial No. 35 in column 4, the expression "Group 'D' shall be substituted with the expression "Group 'C'".
OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 2021(22) In Serial No. 35 in column 5, the expression "Rs. 5200-20200+1300" shall be substituted with the expression "Rs. 5200- -20200-1800".
(23) In Serial No. 35 in column 11, the expression "The department shall identify the work/duties to be performed by the male and female employees under the Multitasking system before appointing the candidates" shall be substituted with the expression "By direct recruitment: Note- The department shall identify the work duties to be performed by the male and female employees under the Multi-tasking system".
By order and in the name of the
Governor of Goa.
Dasharath Redkar, Director/ex officio Joint
Secretary (Environment & Climate Change).
Porvorim, 7th January, 2021.
———ttt———
Department of General Administration __
Notification
23/1/87-GA&C (Vol.IV)/2593
In exercise of the powers conferred by article 166 of the Constitution of India and all other powers enabling him in this behalf, the Governor of Goa hereby makes the rules so as to further amend the Business of the Government of Goa (Allocation) Rules, 1987, as follows, namely:—
1. Short title and commencement.— (1) These rules may be called the Business of the Government of Goa (Allocation) (Thirty- eighth Amendment) Rules, 2020.
(2) They shall come into force on the date
of their publication in the Official Gazette.
2. Amendment of Schedule.— In the Schedule appended to the Business of the Government of Goa (Allocation) Rules, 1987,-
(i) at serial number 28, under the
heading "Department of Personnel",–
(a) under item (b), sub-item (iia) shall
be omitted;
(b) item (q) shall be omitted;
(ii) at serial number 36, under the heading "Department of Revenue", after item (t), the following item shall be inserted, namely:—
"(u) Establishment of Collectorates in
Goa.".
By order and in the name of the Governor
of Goa.
Shripad Arlekar, Under Secretary (GA-II).
Porvorim, 5th January, 2021.
———ttt———
Department of River Navigation __
Notification
RND/Accts/Toll Fee/2020-2021/1641
In exercise of the powers conferred by sub- -section (2) of Section 4 of the Goa Ferries Act, 1990 (Goa Act 9 of 1990) and in supersession of earlier Notification No. RND/ Accts/Toll Fee/2019-20/1810 dated 06-02-2020 in this regard the Government of Goa hereby fixes the rates of special trips for various ferry boats in the State of Goa as specified in the Scheduled hereto with effect from the date of publication of this Notification in the Official Gazette.
SCHEDULE
(1)
Sr. Ferry Routes Item Fare No.
(In Rs.)
1 2 3 4
1. Cumbharjua/Gaundalim Special Trip 100.00
2. Tonca/Sarmanas Special Trip 100.00
3. Old Goa/Piedade Special Trip 100.00
4. Volvoi/Maina Special Trip 100.00
5. Volvoi/Surla Special Trip 100.00
6. St. Pedro/Diwar Special Trip 100.00
7. Panaji/Betim Special Trip 100.00
8. Kerim/Tiracol Special Trip 100.00
9. Camurli/Tuem Special Trip 100.00
10. Ribandar/Chorao Special Trip 100.00
11. Vaxim/Amboi Special Trip 100.00 OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 2021 1 2 3 4
12. Narva/Diwar Special Trip 100.00
13. Tolto/Dauji Special Trip 100.00
14. Rassai/Durbhat Special Trip 100.00
15. Adpai/Rassai Special Trip 100.00
16. Rai/Shiroda Special Trip 100.00
17. Pomburpa/Chorao Special Trip 100.00
18. Cortalim/Madkai Special Trip 250.00
(2) Hire charges of ferry boat/launch is Rs. 2000/- per hour irrespective of size of ferry boat/launch. Less than ½ hour will be considered as ½ hour and more than ½ hour as full hour.
By order and in the name of the
Governor of Goa.
Capt. Premlal Sirsaiker, Captain of Ports/
/ex officio Joint Secretary (RND).
Betim, 5th January, 2021.
———ttt———
Department of Science and Technology and Waste Management __
Addendum
227-10-2016/STE-DIR/965
Read Notification No. 227-10-2016/STE-DIR/
/15 dated 09-07-2020.
In the above read notification, the following sub-clause may be inserted after clause 5 (iv), so as to amend the scheme, notified vide above read notification, published in the Official Gazette, Series I No. 5 dated 30-04-2020.
"5 (v) Guidelines of the Scheme:—
a) The Headmaster/Principal of the institution should ensure selection of students of Standard 8th, 9th or 10th of their respective High Schools. To be eligible, minimum marks obtained in Science subject should be 50% for ST category and 75% for General category for the last 2 academic years. The ST Students to be selected based on ST certificate issued by Competent Authority.
b) Selection for Higher Secondary students shall be based on marks obtained in previous academic year i.e. either Standard 10th or Standard 11th with minimum of 50% for ST and 75% for General category. Only students from Science stream shall be eligible.
c) Schools have the choice to select an Institution of Excellence of their interest in the field of Science and Technology within the Country for such visit.
d) A group can have maximum of 5 students and 1 teacher of the same School/ Higher Secondary or combination of multiple Schools/Higher Secondaries of the same taluka. In the event a group comprises of more than one School/Higher Secondary Grant in Aid shall be given to the applicant School/Higher Secondary which shall manage the amount for the entire group. It may be noted that maximum of 10 such groups are entitled to avail the benefit per year under the scheme.
e) A group must have minimum
2 students belonging to ST category.
f) If the group has even one girl child, then the accompanying teacher must be female.
g) An amount of Rs. 50,000/- to each group of students/teachers shall be provided per trip. A School can avail the benefit of the scheme once a year.
h) Wherever, possible and available Government accommodation should be used for the visiting students/teachers and travel mode shall be railway, bus etc.
i) The School shall apply in Form I appended to the Scheme preferably 2 months prior to the visit.
By order and in the name of the Governor
of Goa.
Levinson J. Martins, Director (S&T&WM)
& ex officio Joint Secretary.
Porvorim, 6th January, 2021.
OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 2021Department of Transport
Directorate of Transport
__
And therefore to make it simple and flexible so as to meet the desired results i.e. for immediate monetary help to road accidents victims, the scheme is modified as under:—
Notification
D.Tpt/Accts/TRANS/2021/54
Read: Notification No. D.Tpt/Accts/TRANS/ 2015/2141 dated 19-06-2015 published in the Official Gazette, Series I No. 13 dated 25-06-2015.
The Government of Goa is pleased to notify the scheme after modification titled as "The Goa State Interim Compensation to Road Accident Victims, 2020", which was earlier titled as "The Goa State Interim Compensation to Road Accident Victims, 2015".
Preamble.— Increase in number of vehicles results in traffic congestion and consequentially in road accidents. While Government does its best to minimize if not eliminate, some tragic accidents are inevitable. Every year an approximately 250- 300 people lose their lives and large number are injured, some with permanent disability and others with partial disability and more often than not, the deceased/injured happen to be the only bread earner of the family and not covered by any life insurance cover and in the event of death and disability of such persons, the entire family is disturbed emotionally, psychologically and financially.
And whereas Government has proposed to provide such families Financial Assistance irrespective of insurance cover enjoyed by the victim.
And in order to fulfill the given assurance as well as for effective implementation of the assurance, the Government was pleased to enact a scheme.
And whereas it has been observed that the Existing Scheme is not meeting the expected results due to the cumbersome process in general and provision regarding Insurance coverage of any nature disqualifying the beneficiary in specific, and therefore in view of the above, the Existing Scheme is modified to that extent.
(1) Title.— The scheme shall be called "the Goa State Interim Compensation to Road Accident Victims, 2020".
(2) Commencement.— It shall come into force from the date of publication in Official Gazette and shall be valid for five years from the date of its notification.
(3) Definitions.— In this scheme, unless there is anything repugnant to the subject or context—
(i) Beneficiary:— "Beneficiary" means the person entitled to receive the compensation/financial assistance paid under the scheme. For the purpose of this scheme entitlement of beneficiary to the sum of compensation shall be in order of priority as under:–
(i) In case of Death of the person/victim of road accident his/her:- (i) spouse (ii) son(s) and unmarried daughter(s) (divided equally) (iii) parents of the victim (iv) unmarried brother(s) and sister(s).
(ii) In case of permanent injury (i) victim or in case he is unable to avail the benefit himself (ii) his/her spouse (iii) daughter(s)/son(s)/mother/father.
In case of any dispute with respect to the proportion of amount of compensation, the decision of the Director (Transport) shall be final.
(ii) Death:— "Death" means a death on account of an accident on the spot or within 12 months of accident on account of any injury suffered during the accident provided it be the sole and direct cause of the death as cer tified by Registered Medical Practitioner.
(iii) Family:— The term family shall include spouse of the victim, son(s), unmarried daughter(s), mother and father, unmarried brother(s) and sister(s).
OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 2021(iv) Permanent injury:— "Permanent injury" means an injury that results in victim not able to carry on any business or occupation as he was carrying on before the accident and so certified by Superintendent, Goa Medical College or Director of Health Services or their designated officials for the purpose of the scheme.
(v) Victim:– "Victim" for purpose of short term relief means "any person who dies in road accident within the State of Goa irrespective of domicile" and for long term relief means "any person who has suffered injury requiring hospitalization having (15) fifteen years of permanent residence in the State of Goa.
(4) Scope of the Scheme.— The Scheme provides for financial assistance to the victims/families of victims against accidental death or bodily injury caused by external, violent visible means in road accidents.
(5) The Scheme shall provide for:–
(I) Short Term Reliefs: (a) In case of Death on road/In case of Death in Hospital/any other place but where cause of death attributable to the accident-Upfront (financial assistance) payment of Rs. 50,000/- (Rupees fifty thousand only) based on the application as per Annexure 'A' made to the Director of Transport by the member of the family of the victim. The payment of financial assistance to be made in the following order:–
(i) Spouse of the victim.
(ii) Daughter(s).
(iii) Son(s).
(iv) Mother.
(v) Father.
The above payment is to be made without verification of any other conditions. The compensation shall be paid as per clause (7) below.
(b) In case of any serious injury suffered in road accident and the injured requiring hospitalization of more than 07 days period – an immediate payment of compensation of Rs. 25,000/- (Rupees twenty five thousand only) based on the application as per Annexure 'A' made to the Director of Transport by the victim or any member of the family of the injured. The payment of the financial assistance to be made in the following order:—
(i) Spouse of the victim.
(ii) Daughter(s).
(iii) Son(s).
(iv) Mother.
(v) Father.
The above payment is to be made without verification of any other conditions. The Compensation shall be paid as per clause (7) below.
(II) Long Term Reliefs: The long term reliefs shall be applicable to those, whose family income i.e. cumulative income of spouse/daughter(s)/son(s) af ter the accident is less than 3.00 lakhs and the same shall be paid as per clause (7) after deducting any compensation already paid under clause (I) above i.e. under Short Term Relief.
(a) Rs. 2.00 lakhs in case of death;
(b) Rs. 1.50 lakhs in case of Permanent
injury;
(c) Rs. 1.00 lakh in case of serious/ permanent injury not leading to loss of job/occupation but where hospitalization exceeds 60 days immediately after accident;
(d) Rs. 50,000/- in case of injuries other than specified above but requires hospitalisation upto 60 days after but exceeding 7 days;
(e) Rs. 10,000/- in case of injuries requiring 3 to 7 days of hospitalisation.
(6) The scheme provides for disbursement of compensation to the families of Road OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 2021 Accident Victims by the Transport Department on the basis of procedure as at Annexure 'A', 'B' and 'C'.
(7) The payment of compensation shall be
made as under:—
(i) In case of death:
(a) Surviving spouse;
(b) In absence of (a) above, the amount of compensation to be divided equally amongst the son(s) and unmarried daughter(s).
(c) In absence of (a) and (b), parents;
(d) In case of absence of (a), (b), (c),
unmarried brother(s)/sister(s).
(e) In case of absence of (a), (b), (c) and (d) then no compensation shall be paid.
(ii) In case of permanent injury:
(a) To the survivor.
(b) To any other relation as indicated in clause 7 (i) above, in order as indicated in case the survivor is not medically in condition to avail the same.
(8) Procedure for claiming the compensation. — (a) Upon the happening of any event which may give rise to a claim under this scheme, an application in the prescribed proforma with full particulars must be submitted online on the Department website goatransport.gov.in or manually to the Director, Directorate of Transport within a period of 180 days of the happening of such event for Long Term Relief and within 30 days for Short Term Relief.
(b) Documentary/Satisfactory proof upon which a claim is based, shall be furnished to the Government along with the claim.
(c) Medical Officer or other authorized person of the Government shall be allowed to examine the injured person(s) to verify the nature of alleged injury or disablement if it is reasonably required by the Department for finalization of the claim.
(d) No relaxation for payment to any person
including legal heirs.
(e) No relaxation in time period for
application.
(9) Procedure for disbursement.— Compensation under this scheme shall be disbursed by the Directorate of Transport, 1st Floor, Junta House, Panaji-Goa.
(10) Applicability.— (a) To any victim in
the State of Goa for Short Term Relief.
(b) To any victim with 15 years of Residence
in the State of Goa for Long Term Relief.
(11) The modified scheme shall be applicable to all cases on or after 19-06-2015.
(12) This compensation paid is not insurance but it is a compassionate payment by State Government to overcome plight faced by the victim and his family due to trauma and expenses incurred. It is not right of any one and it is totally at the discretion of Government and subject to budgetar y provision.
(13) The said compensation paid is not subject to any deductions by insurance company (Refer Clause 12).
(14) Constitution of the Screening Committee.— The Screening Committee shall consist of the following Members:-
1. Director of Transport Chairman.
2. Deputy Director of Member.
Transport, North, Panaji
3. Deputy Director of Member.
Transport, South, Margao
4. Accounts Officer Member
Secretary.
This issue with the concurrence of the Finance Department vide inward No. 4020/F dated 12-11-2020.
By order and in the name of the
Governor of Goa.
Rajan Satardekar, Director & ex officio Addl.
Secretary (Transport).
Panaji, 7th January, 2021.
OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 2021ANNEXURE "A"
PROCEDURE FOR CLAIMING COMPENSATION
I - Short Term Reliefs:–
1. Name of the claimant.
2. Name of the Road Accident Victim.
3. Relationship with the victim/deceased.
4. Permanent Residential Address.
5. Details of Accident: (i) Place, day, date and time.
ANNEXURE "B"
PROCEDURE FOR CLAIMING COMPENSATION
II – Long Term Reliefs:–
1. (a) Name of the claimant:
(b) Name of the Road Accident Victim:
(c) Relationship with the victim/deceased:
2. Permanent Residential Address:
(Enclose Residence/Domicile Certificate issued by the Competent Authority).
3. Profession/Occupation/Trade of Business of the Road Accident Victim:
4. No. of Dependant on the Claimant/Road Accident Victim:
5. Details of Accident:
(i) Day, date & time:
(ii) Full particulars of the cause and the injuries sustained:
(attach medical report in original)
6. Whether the accident is registered by the Traffic Police? (Attested copy of the FIR/Panchanama be enclosed)
7. Give name & address of the witness of the accident if any:
8. The nature and extent of injuries:
(specify death, permanent disability or partial disability)
9. (a) Is the Road Accident Victim insured?
(b) If so, please give full details of such company or insurer:
(Attach an Affidavit in the prescribed format as per overleaf).
I, …………………………………………………. declare that the information given is true and correct to the best of my knowledge and belief and that I have not concealed or suppressed any material facts and incase any such things are noticed at later stage, compensation paid shall be forfeited.
Signature
Name & Address
ANNEXURE "C"
PROCEDURE FOR CLAIMING COMPENSATION
Documents to be submitted for Road Accident Claim:
1. Copy of FIR issued by the concerned Police Station OR Police Station Diary in case of self accident.
2. Copy of Police Panchanama.
3. Residence/Domicile Certificate/Satisfactory documents of the deceased/victim of minimum period of 15 years preceding his/her date of demise issued by the Competent Authority.
OFFICIAL GAZETTE — GOVT. OF GOA SERIES I No. 42 14TH JANUARY, 20214. Medical Report.
5. Death Certificate.
6. Copy of Ration Card.
7. EPIC Card or Aadhaar Card or PAN Card or any other Bank Passbook with Photo or any other Photo Identity issued by State or Central Government Authority.
8. Income Certificate if there are dependants on the claimant.
9. Marriage Certificate in case of the claimant is surviving spouse. Wherever such document is not available, Birth Certificate of the child showing name of father and mother.
10. In case of legal heirs of victim (other than spouse), documents in support of the same and NOC from brother(s)/sisters(s).
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