A Domestic Worker who has been registered as a beneficiary may make an application for grant of benefits.
Such application shall be in Form T.
By order and in the name of the Governor of Maharashtra, KAVITA GUPTA, Secretary (Lahour) to Government.
AT VA A SATHROT WY UH-T, AT 3, R0%0/HTH ¢, WH 2%IT 18 FORM A [ See rule 6(1) | Form of Income and expenditure account for the year ending 31 March.......
Figures Figures Figures Figures for the expenditure for the for the Income for the previous current previous current year year year year To By cess administrative Interest on charges investment in securities.
Miscellancous FORM B (See rule 6 (2) ) PROVISIONAL BUDGET ................ Board.
Form of Asset Register ... ...
For the year ended 31" March Voucher Particulars Depre: Quantity Now Inadental Total — New Other Nooand of suppliers eiation of Piice churges price value Depre date BilVBills arncles WAt eation adust meat Total :
Yo WEWTE VITEA TAUH F@URUT WIT UH-, T 23, 20%0/WIF §, I 2’32 FORM C [ See rule 6 (3)] Board Form of balance-sheet as at 31" March Figures Liubilities Figures for Figures for Assuts Figures for the for the the eurrent the previous Cash and current Year previous year year Bank vear Balance FORM D | See Rule 7 ................ Board.
Final revised Budget estimates for the year ......... and original Budget etimates for the year ... " Parti- Original Amount Actual Estimated Final Esticulars estimate provided in amount expen- revised mate for theyear the first spent upto diture estimates for the Remarks revised December from for the year Budget January year estimates to March for the year HERTZ AT TATT JAIRVT W Q- AT 23, 000/WTE §, Ik 2/3% FORM F | See Rule 9(1) | Application for Registrati?n as Beneficiary PASSPORT SIZE PHOTO Y Full Name & Permanent address of the Applicant Date of Birth/Age Sex :| Male/Female Nationality Whether belongs to :| SC/ST/OBC/Others Local address S | o f o | s l w l e Name and address of the present Employer/ Employers Nature of work o Date of employment Wages per day/per month Educational Qualification & professional skills.
Ration Card No.or Voter Identity card No, Name of the Nominee & relation with beneficiary & address.
I hereby declare that the above information is true and correct to the best of my knowledge and belief’ Place :
Date : Signature/Thumb impression of the Applicant.
TR VIR AT ST AT -, S 33, R0Re/MTT @, I 2232 For Office use only Place Date Received fee of Rs _ Application accepted/rejected Signature of Registering Officer with Seal.
Receipt Sr.No.
Received Rs. as Registration Fees [rom Shri/fSmt Date : Signature of Board Official WERTE STHA ITAUA AATGWUT UTT UH-F, AR 33, F0%0/WIF ¢, I1& 2939 5 FORM G | See Rule 9 (3) | Register of Beneficiaries
1. Full name
2. Permanent Address
3. Date of Birth/age :
4. Sex : Male/Female
5. Registration No
6. Name & Relation of nominee With address.
7. Whether police verification is obtained :
If yes date of verification
8. Whether medical verification is obtained :
9. Particulars of employment.
Present Nature of Name of Date of Date of Signature Address work and the present employ- completion of Board designation employer/s ment of work Official with Address and Tel.No.
(1 (2) 3) (4) 5) 6) 4RI FIA TAGH SF@TGROT WT CH-A, ST 93, {0%0/WIE &, I 2’3 FORM E (See Rule 8 Domestic Workers Welfare Board, Annual report for the year
1. Board
(1) Full registered address
(2) Date of constitution
(3) Name of chairman
(4) Members of the Board
(5) Regional offices with address (if any) 6) Number of staff of the board with gradewise tincluding regional otfices).
1. Membership :
(i) Number of beneficiaries registered with the Board.
(i) Number of beneficiaries registered during the audit period
111. Meetings:
State the number of meetings held with dates during the year and names of the members remaining absent.
IV. Audit:
(i) The date of the last audit
(ii) Have any irregularities been mentioned in the previous audit ? If so, state the position regarding compliance thereof.
V. Internal audit:
(@) Is there a formal internal audit system in operation ?
() Any special areas which are taken up by a internal auditor ?
If yes, list them.
() Who had done the internal audit? Whether the internal auditor is from the panel of auditors ?
(d) State whether there is proper co-ordination between the Government auditor and the internal auditor.
(¢) Whether recommendations made by the internal auditor have been complied with by the Board, if not, specify them.
VL. cash, bank balances and securities :
(A) Cash— (@) Whether the cash is counted physically by the auditor ?
If yes, give the date.
(b)Y Who produced the cash for counting ? Give his name and designation. Is he authorized to kecp cash ? Whether the cash balance was within the limits stipulated ?
FERTE, VT TATA SFRTAROT W WR-F, AT 33, 0%0/MTT 2, W 9833 34 () Is it correct according to cash book ?
(d) Are arrangements for safety of cash in safe and cash in transit adequate?
(e) Whether any insurance policy for money-in-transit, cash in safe and fidelity guarantee is taken out ? If yes, specify the sum insured agairst each category.
(B) Bank balance - (@) Do the bank balances shown in the bank statements/pass book tally with the bank book? If not, whether any reconciliation statement is prepared? Attached statement
(b) Wether confirmation of balance are obtained from all the banks, (C) Securities - (@) Verify securities physically and see whether they are in the name of the board,
(b) 1f securities are lodged with the bank, are relevant certificates obtained ?
(d) Is investment register is kept and written upto date ?
() Whether the aggregate amount as per the register tallys with the ledger ? If not what is the quantum of difference ?
() Amount not received upon maturity, VIL. Moveable and immoveable properties :
l@) Are relevant registers maintained upto date ?
(B) Verified property physically and obtained list. Do the balanc tally with balance sheet features ?
(¢) In case of immovable properties including land, verify title deeds and see whether they are in the name of the Board.
(d) If the property is duty insured whether necessary ? If so, give details.
() Depreciation :
1. Is due depreciation charges ?
2. State the rates of depreciation charged on various assets VIIL. Receipts during the year under report.
(1 Amount of grants/loans received from the State Government (20 Amount of contribution received from the beneficiaries, (3) Amount of cess received, “f, FERTE VIEA {TATA ST W UR-A, TR 23, Y0%o/WIE ¢, I ]IV
(4) Amount of registration fees receved from the benecifiaries.
(5) Any other source.
IX. Expenditure during the year under repor
(1) Financial assistance provided to the benefic details schemewise).
(2) Administrative expenditure (including salary)
(3) Expenditure on other heads (specify the heads).
ries (give the
(1) Litigations :
i Number of court cases against board, b1 Number of court cases filed by the hoard.
(2) Inspection i— (@ Whether any inspection has been carricd out by state Government authority,
(b) Orders/directions issued if any.
(3) Proposals :— Pending proposals if any with the Government.
Annexure — Internal auditors report.
HERTE VIR TTATA W G UH-A, ST 93, R000/WTE §, WH R332 .
FORM H | See Rule 10| Identity Card/Smart Card.
Sr. No. Photo of the worker
(1) Name of the worker
(2) Father/Hushand's name
(3) Address
(4) Age, Date of birth
(5) Blood group
(6) Ration card No./ Voter Identity Card No.
and date of issue
(7) Place of work
(8) Nature of work (9 Name of employer / employers (100 Particulars of dependants Qi Sr. No. Name L Age Relationship 1 2 3 4 ] 5 . = 7 Signature of worker Signature of Secretary/ Date of issue : Authorised person 5, WAWTE VIEA TAUA SEERT W0 UE-F, AT 23, 080/ ¢, I ]I FORM | | See Rules 12 | Application for obtaining benefits by the beneficiary.
(1) Full name of beneficiary
(a) Permanent address
(b) Present address
(2) Registration No. & date
(3) Nature of work
(4) Employers name & address
(5) Date of appointment
(6) Payment per day/per, month
(7) Nomination of beneficiary relation With beneficiary,Name and address
(8) Particulars of benefits (@ The particulars of the documents Attached.
Place : Signature/Thumb impression of applicant.
o WRTTALF OF OWERNAMENT FIINTING, STATIORERY AND 11HLICATION. PRINTED AND 1 ISIEN BY ST PR IGAM 1WANNATIE(ORAV FRINTED) VT GOVENNNIENT (ENTRAL PRESS 218 NEUME SURNANH Tty LTAKA KOAI MUMINAL 100 004 ANV UBLISTED AT HIRKCTORNTE OF GOVERNMEXT PIINTING STATIONERY ANS VUBLICATION 213, NETAILSURIASILIROAD. CHARNT ROAD MURIBAL 400 008 EDITOR - S1TIPARSHLRAM JAGANNATI (KISAVI