MANIPUR hm GAZETTE )h EXTRAORDINARY PUBLISHED BY AUTHORITY No. 481 Imphal, Thursday, February, 28, 2019 (Phalguna 9, 1940) GOVERNMENT OF MANIPUR SECRETARIAT: CONSUMER AFFAIRS F00D & PUBLIC DISTRIBUTION DEPARTMENT NOTIFICATION Imphal, the 27th February, 2019 No. 5/1/2014-CAF&PD: Whereas, the draft Manipur Food Security Rules, 2018 was previously notified in compliance ofsub-section (1) of Section 40 ofthe National Food Security Act 2013 (No. 20 of 2013) inviting general views or suggestions from members of the public and interested groups/ organisations;
And whereas, within the stipulated period df‘ 15 days for submission of such views or suggestions, no views or suggestions have been received from any person/organisations with respect to the said drafi Rules; “' Now therefore, in exercise of the powers conferred by Section 40 of the National Food Security Act, 2013 (No. 20 of 2013), the Governor of Manipur is pleased to make the following Rules, namely;
1. Short title, extent and commencement:-
(1)These rules may be called the Manipur Food Security Rules, 2019.
(2)They shall extend to the whole of the State ofManipur. '
(3)They shall come into force from the date oftheir publication in the Official Gazette.
2. Definitions.—(1 )In these rules, unless the context otherwise reqfiTFeSu m
(i) “Act” means the National Food Security Act, 2013(No.20 of 2013);
(ii)“Chapter”, “Section” and “Schedule" means respectively Chapter, Section of, and Schedule to the Act;
(iii)“Con}petent Authority” means the Director, Consumer Affairs, Food & Public Distribution, Government of Manipur; '
(iv)“Designated Authority” means District Civil Supply Officer of the District or any other officer designated by the Competent Authority; .
(v) “Form” means the form appended to this rule;
(vi)“Govemment” means the Government of Manipur; and
(vii)“Household” means a nuclear family comprising mother, father and their children.
Dependent parent, single women which includes widow, abandoned, separate, divorced or unmarried women over 35 (thirty—five) years of age with or without their dependent chiidren, disabled with or without their dependent children, even if they have a common roof or hearth will be treated as a separate household for the purpose ofthis rule;
(2) All other words and expressions not defined herein but defined in the National Food Security Act, 2013(No.20 of 2013), the Essential Commodities Act, 1955 (10 of 1955) or any other relevant Act shall have the same meaning respectively assigned to them in those Acts.
3. Dis 2 play in Public Domain for the purpose of Section llof the Act:-
(1) On completion of each identification process, the Government shall display prominently and place in public domain the list ofnames of persons/household identified for inclusion in ‘Priority’ or ‘Antyodaya’ category.
(2) The list of names of eligible household shall be displayed at the Gram Panchayat/Ward Office, Village Council/Local Council Office and ration shop prominently.
(3) The State Govemment shall also display the list of eligible households on its website in English or in the official language of the State.
4. Guidelines for identification of priority households for the purpose of Section 10 (1) (b) of the Act:-
(1)Identification of priority household shall be made through applicationbased upon inclusion and exclusion criteria to be determined by the State Government from time to time subject to the following restrictions:
(0
(ii) Inclusion criteria:— The households having annual income of less than Rs. 1 lakh and fulfilling the following criteria shall be considered as eligible households for inclusion in the Antyodaya Anna Yojana(AAY) and Priority category, as the case may be:
(a) Households with disabled person [as defined in the Persons with Disabilities(Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (No.1 of 1996)] subject to submission of prescribed medical certificate at Form - I to be obtained from the State Medical Board for issue of Disability Certificate;
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(b) Single women (including widows, unmarried and separated and deserted women), living in household as dependent or as head of household;
(c) Children living without protection;
(d) Persons living with HIV;
(e) Occupationally vulnerable groups like unskilled construction workers, casual daily wages labour, casual domestic workers, cycle rickshaw drivers, unskilled workers in small household enterprises and unskilled workers in household industries; and (0 Any other households having annual income of less than Rs. 1 lakh per annum.
Exclusion criteria: —Notwithstanding their fulfilling the inclusion criteria, the following hOuseholds shall not be eligible:-
(a) If any member of a household owns a light (Four Wheeler) or heavy vehicle;
(b) if the household is receiving ration/food subsidy under any other scheme;.and
(c) If any member of the household is income'tax payee.
(2) Mode of application for inclusion in the priority householdszThe eldest female shall be treated as Head of household. ' Applicants shall be assisted in filling up the forms in the office of the concerned Deputy Commissioner/Additional Deputy Commissioner. The 3 application form to-be submitted by the head of the householdshall be in Form-Z enclosing the following documents:-
(a) Residence proof of the applicant;
(b) Income Certificate issued by the Revenue Department, wherever applicable;
(c) Ration card (if the applicant or any member of the household has ration card of any type); and
(d) An undertaking by the applicant duly attested by an Executive Magistrate in Form — 2 that the applicant does not fall under any ofthe exclusion categories.
(3) Procedure for finalization of list of priority households shall be as follows:-
(a) Applications received shall be scrutinized.
(b) Field verification shall be conducted. .
(0) Before declaring any household as eligible, the Deputy Commissioner/Additional Deputy Commissionershall issue a public notice in the local media that he intends to include such household(s) in the category of eligible households and 'shall publish it on notice board of his office for a minimum 'period of 7 days.
(d) Any objection for inclusion of any household in the category of eligible household shall be filed within 7 days of publication of the list. The Deputy Commissioner ladditional Deputy Commissionershall consider the objection and opportunity of being heard shall be given to the applicant before rejecting his application in response to any such objection.
(e) After disposing of the objections received, the Deputy Commissioner/ Additional Deputy Commissionershall include the applicant household'in the list of eligible household category.
(t) A new ration card titled “National Food Security Card” shall be issued to the selected applicant.
5. List of eligible households for the purpose of Section 10(2) of the Act:-
(1) The Government shall identify the list of eligible household based on criteria laid out in the guidelines and under these rules.
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(2) The Government shall regularly update the list of eligible beneficiaries:
(3)
Provided that the Government may take into consideration the social and economic data captured by the Census of India for the purpdse of identification of eligible beneficiaries under the Act.
Any person/organisation/Government authority who has reasonable cause to believe that any person/household or a group of persons/group of households who should have been included in the priority/AAY category and their name has not' been included in the list relevant to that category; or any person/household or a group of persons/group of household who should not have'been included in the ptiority/AAY categdry and their name has been included in the list relevant to that category; may 4 file a complaint before the Deputy Commissioner/Additional Deputy Commissioner for inclusion or elimination, as the case may be, of names of such persons/households.
6. Issue of ration cards: -
(1)Afier identification of eligible households, ration cards shall be issued to all selected households by the Deputy Commissioner/Additional Deputy Commissioner. The ration card shall have all‘ necessary details about the household, scale of ration and information required under End to End Computerisation ' of Targeted Public Distribution System (TPDS) project. ~
(2) The eldest woman who is not less than eighteen years of age, in every eligible household, shall be head of the household for the purpose of issue of ration cards.
(3) Where a household at any time does not have a woman or a woman of eighteen years of age or above, but has a female member below the age of eighteen years, then, the eldest male member of the househdld shall be the .head of the household for the purpose of issue of ration card and the female member, on attaining the age of eighteen years, shall become the head of the household for such ration cards in place of such male member.
(4) The Government shall issue a ration card only to‘ a citizen of India who is a resident of Manipurand fulfils the Conditions for getting a ration card as prescribed under these rules.
(5) The Government shall print separate and/or distinct ration cards for the Antyodaya I households and the Priority households.
(6) Ration card shall not be used as a document of identityor proof of residence.
(7) A new ration card or modification in the existing ration card may be obtained in Form —
2. The modification may be on account of shifting of residence, birth of child, change in category of beneficiary, corrections in the details mentioned in the card, etc. The form may include requisite details including Aadhaar number, bank account details, and mobile telephone number. For this purpose, the Government shall capture the information in the software prepared by National Informatics Centre or as per the fields and standards prescribed by the Central Government. ' 1’
(8) The Government shall maintain the ration card data in the digitized database and ensure that issue of a new ration card and modifieation in the existing ration card is undertaken through the software programme so that the database is automatically updated.
(9) The Competent Authority shall appoint the Designated Authority for receiving, registering, acknowledging and processing of application for” issuance of ration card or modification in the ration card. Such person shall not delegate this function to any staff or officer functioning under him unless permission is granted on exigencies by the Government in writing.
5 The Government may also receive the application through online mechanism including use of e-service centres, kiosks, etc. A citizen may apply for a new Ration Card at WWW.PDSMANIPUR.NIC.II\L
7. Food security allowance: —In case of non-supply of the entitled quantities of foodgrains or meals to entitled person, such person shall be entitled to receive such food security .allowance from the Government to be paid to each person, within such time and manner as may be prescribed by the Central Government.
8. Grievance Redressal Mechanism:-
(l)For redressal of public complaints, an Officer of Consumer Afi‘airs, Food & Public Distribution, shall be designated as Nodal Officerfor receivingcomplaints under Targeted Public Distribution System who may forward the complaints to District Grievance Redressal Officer(DGRO).
(2) Lodging of Complaints:
(a) Any aggrieved person can file and submit his complaint to the District Grievance Redressal Officer in writing in Form — 3 or through online in the portalWWW.PDSMANIPURNICJN.
(b) An acknowledgement receipt shall be given on receipt of such complaint.
(0) To facilitate the grievance redressal mechanism, the Consumer Affairs, Food &' Public Distribution Department shall put in place call centres, websites and help line numbers through the departmental website and other media.
(3) Disposal of Complaints:
(3)
(b) (C)
(d) The receipt and disposal of complaints shall be recorded in a ComplaintmRegister with fulldetails.» .
Any complaint received shall be disposed off within 30 (thirty) working days by District Grievance Redressal Officer.
If‘the nature of the complaint necessitates enquiry or spot verification,‘it shall be completed within 15 (fifieen) working days and necessary action to address the grievances shall be taken within 45 (forty-five) days from the date of receipt of complaint.
In case a complaint has to be resolved by any other authority, concerned Greivence Redressal Officer shall conduct preliminary enquiry and refer the matter to such authority within 7 (seven) working days under intimation to the complainant. Such authority shall inform the Grievance Redressal Authority of its decision and action taken within 45 (forty-five) days upon receipt of the complaint.
The complainant shall be informed of the action taken, in writing, through registered post and acknowledgement receipt shall be obtained. '
(4) Appeals:
(a) All appeals shall be made within 7 (seven) days from the date of the'issuance of the order.
(b) Any complainant or the officer or authority against whom any order has been passed, who is not satisfied with such order, may file an appeal against such order before the State Food Commission. -
(c) The State Food Commission shall dispose of anyappeal submitted to it within 45 (forty—five) days.
(d) The decisions thereon shall be eommunicated to the appellants1n writing through registered post and acknowledgement receipt shall be obtained
(e) The decision of the State Food Commission shall be final.
(5) Contravention and penalty:
(1) Failure to dispose of a complaint within the time prescribed under these rules (i.e., 45 (forty—five) working days) shall be treated as contravention of the Act punishable under section 33 of the Act. Complaint against such failure shall be' lodged.
(ii) Wherever contravention of the provisions of the Act has been proved after due ;
enquiry by the State Government or the District Grievance Redressal Officer or any i other authority authorized by the State Government, action in accordance with the 1 provisions of section 33 ofthe act shall be taken. :
(iii)The provisions of these rules shall not preclude the Government or the Competent { Authority from taking any other action either suo motu or on receipt of complaint, as ;
it may deem fit under any existing laws, rules and guidelines. 3
9.District Grievance Redressal Officer (DGRO):- 1
(l) The State Government may by notification, appoint/designate any officer, not below the 5 rank of ADM or equivalent as the District Grievance Redressal Officer of the Consumer ;
Affairs, Food & Public Distribution Department for each district for expeditious and effective redressal of grievances of the aggrieved persons in matters relating to. the distribution of entitled foodgrains 0r meals under the Act and to enforce the entitlement under the Act.
(2) The District Grievance Redressal Officer (DGRO) shall, subject to the provision contained under sub section (5) of section 15 of the Actsubmit the action taken report in time to the appropriate authority within 10 (ten) days from the date of disposal of 1 grievance. ’
(3) The District Grievance Redressal Officer (DGRO), on receipt of written/online complaints on non-receipt of entitlements by the eligible beneficiaries shall cause to have an enquiry immediately
(4) The District Grievance Redressal Officer (DGRO) shall fix a date for hearing of the cemplaintswithin the time prescribed at such places orin; his office chamber, for the redressal efthe grievance.
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10.State Food Commission:-(l) The Government shall, by notification, constitute a State Food Commission for the purpose of monitoring and reviewing of implementation of the National Food Security Act, 2013.
(2) The State Food Commission shall consist of-
(a) a Chairperson;
(b) five other Members; and
(c) a Member-Secretary, who shall~be an officer of the Government not below the rank of Joint Secretary to the Government:
Provided that there shall be at least two women, whether Chairperson, Member or Member-Seeretary:
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Provided further that there shall be one person belonging to the Scheduled Castes and one person belonging to the Scheduled Tribes, whether Chairperson, Member or Member- Secretary.
(3) The Chairperson and other Members may be appointed from amongst persons —
(a) who are or have been member of the All India Services or any other Civil Services of the Union or State or holding a civil post under the Union or State having knowledge and experience in matters relating to food security, policy making and administration in the field of agriculture, civil supplies, nutrition, health or any allied field; or , I
(b) of eminence in public life with wide knowledge and experience in agriculture, law, human rights, social service, management, nutrition, health, food policy or public administration; or
(0) who have a proven record of work relating to the improvement of the food and nutrition rights of the poor.
(4) (i) Every appointment under sub-rule (2) of this rule shall be made by the State Government on the recommendation of a Selection Committee consisting of the following"members, namely:— Sl. No. Name 1 Designation l 1 Chief Secretary, Govt. of Manipur Chairman 2 Administrative Secretary (CAF&PD), Govt. of Manipur. Member 3 Director (CAF&PD), Manipur ‘ Member
(ii) The Selection committee shall select and recommend a panel. of names, within such period as may be fixed by the State Government for the appointment of the Chairperson, other Members and Member Secretary of the State Food Commission (SFC). .
(iii) While selecting the names of the Chairperson, other Members and Member Secretary of the State Food Commission(SFC), due regard shall be given to the provisions of Section 16 of the Act.
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(iv) Terms and conditions of appointment and procedure for meeting ofthe Commission,-
(a) Terms and conditions of appointment of Chairperson, other Members and Member Secretary and their salaries and allowances or remuneration payable to and other terms and conditions shall be as fixed by the State Government from time to time.
(b) Subject to the provisions in the Act and the Rules made there under, the Commission ishall have the powers to formulate its own procedure.
(c) The Chairperson of the Commission may‘ direct the Member Secretary to call the meeting of the Commission which may be held from time to time as the Chairperson may direct.
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(5) The Chairperson and every other Member shall hold office for a term not exceeding five years from the date on which he enters upon his office and shall be eligible for reappointment:
Provided that no person shall hold office as the Chairperson or other Member after he has attained the age of sixty-five years.
(6) The State Commission shall undertake the following functions, namely:
(a) monitor and evaluate the implementation of the Act, in relation to the State;
(b) either suo motu or on receipt of complaint inquire into violations of entitlements provided under the Act;
(e) give advice to the Government 011 effective implementation ofthe Act;
((1) give advice to the Government, their agencies, autonomous bodies as well as nongovernmental organisations involved in delivery of relevant services, for the effective implementation of food and nutrition related schemes, to enable individuals to fully access their entitlements specified in the Act;
(e) hear appeals against orders of the District Grievance Redressal Officer;
(t) prepare annual reports which shall be laid before the State Legislature by the Government.
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(7) The Government shall make available to the State Commission, such administrative and technical staff, as it may consider necessary for proper functioning of the State Commission.
(8) The salaries, allowances and condition of service of the staff under sub-rulc(7) shall be similar and equivalent to the salary, allowances and condition of service applicable and admissible to the equivalent ranks of the employees of the State Government or us decided by the Government from time to time.
(9) The Government may remove from office the Chairperson or any Member, who-
(a) is, or at any time has been, adjudged as an insolvent; or
(b) has become physieally or mentally incapable of acting as a member; or
(c) has been convicted of an offence which, in the opinion of the Govemmenl, involves moral turpitude; or 9
(d) has acquired such financial or other interest as is likely to affect prejudicially his functions as a member; or -
(e) has so abused his position as to render his continuation in office detrimental to the public interest.
(10) No such Chairperson or Member shall be removed under clause (d) or clause (e) of sub— rule (9) unless he has been given a reasonable opportunity of being heard in the matter.
( l l) The Government shall provide for salary and allowances of Chairperson, other Members, ’Member-Secretary, support staff, and other administrative expenses required for proper functioning ofthe State Commission in the form of grant—in-aid.
(I2) The State Food Commission shall, while inquiring into any matter referred to in clauses
(b) and (e) of sub-section (6) of section 16 of the Act, have all the powers of a civil court while trying a suit under the Code of Civil Procedure, 1908 (No.5 of l908),and in particular, in respect of the following matters, namely:-
(a) summoning and enforcing the attendance ofany person and examining him on oath;
(b) discovery and production of any document;
(0) receiving evidence on affidavits;
(d) requisitioning any public record or c0py thereof from any dourt or office; and
(e) issuing commissions for the examination of witnesses or documents.
(13) The State Commission shall have the power to forward any case to a Magistrate having jurisdiction to try the same and the Magistrate to whom any such case is forwarded shall proceed to hear the complaint against the accused as if the case has been forwarded to him under section 346 of the Code of Criminal Procedure, 1973(No. 2 of 1974).
( 14) No act or proceeding of the State Commission shall be invalid merely by reason oil‘-
(a) any vacancy in, or any defect in the constitution of, the State Commission; or
(b) any defect in the appointment of a person as the Chairperson or a Member of the State Colnmission; or
(c) any irregularity in the procedure of the State Commission not affecting the merits of the case. ' '
(15) Notwithstanding anything contained in these rules and the Act, the State Government may, if considers necessary, by notification,designate any existing statutory Commission or a body to exercise and perform the functions of the State Food Commission.
11. Disclosure of record of Targeted Public Distribution System.- (1 ) The records relating to the stock and allocation of foodgrains and other essential commodities of the food godowns of the State, shall be uploaded in the national portal/ departmental website within 2 (two) days of the issue of allocation order.
12.
13.
(2)
(3)
(4)
(5)
(6) 10 The food godown incharge Shall maintain proper accounts relating to distribution of foodgrains and other commodities on day to day basis and the accounts shall be readily available for inspection of the local authorities/ departmental authorities and authorized persons/bodies etc., as andwhen necessary.
The food godown in—charge shall not deal with direct cashtransaction with any individuals or fair price shop. The official shall maintain proper record .of bank receipts and drafts realized on account of sale proceeds which shall be available for inspection by any authorized persons.
Computerization of the Targeted Public Distribution System shall be undertaker: for maintaining transparency in the supply chain management system of foodgrains and other essentialcommodities.
All the information relating to the Targeted Public Distribution System shall be hosted timely in the national and state portal.
The Nodal Officer appointed under Section 14 of the Act, shall disseminate to all concerned on time to time basis through the media and other electronic modes of the clay to day transaction by the Department including such policy decision of the Government in regard to the implementation of schemes under Targeted Public Distribution System.
Conduct of social audit.-
(1)
(2)
(3) (4') The Department shall at regular intervals conduct social audit in the fair priceshops of the book of accounts and other related register maintained by the vendor.
The members of the Block Level Vigilance Committee shall be included as a part of social audit along with any interested stake holders at the time of social audit.
The social audit report fzhall be examined by the District Civil Supplies Officers who shall take appropriate measures as may be necessary to bring in competency in the accounting process in the fair price shops.
In case of any actions found to have taken contrary to the interest ofthe beneficiaries at the time of social audit, shall be brought forthwith to the notice of the District Consumer Affairs, Food & Public Distribution Officer, for taking action as per the relevant law.
Composition and functions of Vigilance Committee.-
(1)' ,For ensuring transparency and proper functioning of the Targeted Public Distribution System and accountability of the functionaries in such system, the Government shall set up Vigilance Committees as specified in the Public Distribution System (Control) Order, 2001, made under the Essential Commodities Act, 1955 (No. 10 of 1955), as amended from time to time, at the State, District, Block and fair price shop levels consisting of such personsas given below in each level giving due representation to the local authorities, the Scheduled Castes, the Scheduled Tribes, women and destitute persons or persons with disability.
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(a) State Level Vigilance Committee on Targeted Public Distribution system (I‘PDS) _ Chairman Member ’ Member , Member Member Member Member Member Member Member Member Secretary
(b) District Level Vigilance Committee for Targeted Public Distribution System
(i) Minister (CAF&PD)
(ii) Minister (RD & PR)
(iii) Minister (MAHUD)
(iv) Minister (TA&Hills)
(v) MPs (Lok Sabha .’ Rajya Sabha)
(vi) MLA (3 nos) to be nominated by Minister (CAF&PD)
(vii) Secretary / Commissioner (CAF&PD) - -
(viii) Secretary / Commissioner (RD & PR) -
(ix) Secretary / Commissioner (MAHUD) -
(x) Director (CAF&PD) 1
(xi) Spl. Secy/Addl.'Secy./Jt. Secy./Dy. Secy./ - Under Secy (CAF&PD) (TPDS).
y (i) Deputy Commissioner
(ii) CEO of the District
(iii) Sub-Divisional Officers ofthe district -
(iv) District Supply Officer
(v) Three each from 'AAY and PHH Card holders -
(vi) One Social / Consumer organisation - (to be nominated by DC) Chairman Member Member Member Secretary Member Member
(c) Block Level Vigilance Committee for Targeted Public Distribution System (TPDS)
(i)Zilla Parishad Member/ ADC Member -
(ii) (to be nominated by Deputy Commissioner) Sub-Divisional Officer (SDO) / Block Development Officer (BDO)
(iii) Representative from District Supply Officer’s - (DSO’S) Office
(iv)Two each from AAY and PHH card Holders - (to be nominated by the SDO/BDO concerned) One Social Worker ofthe area member - (to be nominated by the concerned SDO/BDO) (V) Chairman Member Member Secretary Member Member 12
(d) Fair Price Shop / Panchayat / Municipal / Village Level Vigilance Committee for Targeted Public Distribution System (TPDS)
(i) Pradhan / Councillor of the areal - Chairman Chairman of Village Authority (5:) Repressntative from District Supply Officer’s — Member Secretary (DSO’s) Office
(iii) One card holder each from AAY and PHH - Member
(iv) One Consumer activist / Social worker of reputed - Member to be nominated by District Supply officer concerned The Vigilance Committee shall perform the following functions:-
(i) to regularly supervise the implementation of all schemes under the Act;
(ii) to inform the District Grievance Redressal Officer, in writing, of any violation ofthe provisions of the Act; and
(iii) to inform the District Grievance Redressal Officer, in writing, of any malpractice or misappropriation of funds found by it.
Further: the mcnthly Utilisation Certificates for the Targeted Public Distribution System (TPDS) foodgrains & Public Distribution System (PDS) items shall be jointly signed :-
(i) By the Up-Pradhan or member of the Gram Panchayat / Chairman or Secretary of Village Authority for the Fair Price Shop (FPS) located in the village and the FPS Agent concerned.
(ii) Sub Divisional Officer (SDO) / Block Development Officer (BDO) of the subdivision / block.
(iii) On the basis of the joint Utilisation Certificates (U.C.) furnished by the SDO/BDO concernedf the DC will issue U.C. for the villages and Fair Price Shop (FPS) concerned at the time of subsequent indents to the Directorate of CAF&PD.
(iv) Utilisation Certificate in the case of Public Distribution System (PDS), Superior 1 Kerosene Oil (SKO) shall be signed jointly in the same manner prescribed above and shall be submitted to the Department of CAF&PD on or before 3rd day of the allocation month.
T. RANJIT SINGH, Commissioner (CAP & PD), Government of Manipur.
13 FORM - 1 (see sub-rule (1) of rule 4)
PART -I APPLICATION FORM FOR OBTAINING DISABILITY CERTIFICATE BY PERSONS WITH DISABILITY Registration No........ Dated...........
1. Name (in block letters): ........................................... Photo ......................................... . (2 Passport & '2. Father’s Name (in block letter): ................................... 2 Stamp size) Mother’s Name (in block letter): .............................
3. Date ofBirth: ............. Month .............. Year .............
4. Age at the time of application: .................................... '. .
4. Sex: Male/Female
6. Address: ............... ' ...................................................
a) Pennanent Address: . . . .....................................................
b) Current Address (Le. for Communication) .....................................
7. Educational Status (pl. tick as applicable) i. Post Graduate ii. Graduate iii. ‘ Diploma iv. Higher Secondary v. High School vi. Middle vii. Primary viii. ' I lliterate .,
8. Occupation............. ‘ .................................................
9. Identification mark (i) .................................................
(ii) .................................................
10. Nature of disability: Locomotor/Hearing/Visual/Mental/Others l 1. Period since when disabled: From Birth/Since year. . ............................
b
12. (i) Did you ever apply for issue ofa disability certificate in the past . .‘ ....... Yes/No.
(ii) If yes, details:
' (a) Authority to whom and district in which applied .....................
(b) Result of application ........................................... '
13. Have you ever been issued a disability certificate in the past? If yes, pleased enclosed the true copy.
14. Biood Group .............
14 DECLARATION I hereby declare that all particulars state above are true to the best ofmy knowledge and brief, and no material information has been concealed or misstated. I funher, state that if any inaccuracy in detected in the application, I shall be liable to forfeiture of any benefits derived and other action as per law.
Date:
Place:
Ecld:
1. Proof of Residence (Please tick as application)
(a) Ration Card
(b) Voter Identity Card
(c) Driving License I(d) Bank Passbook
(e) PAN Card (0 Passport (Slgnature or left thumb Impression of person with disability, or of his/her legal guardian in case of persons with mental retardation, autlsm, cerebral palsy and multiple disability)
(g) Telephone, Electricity, Water and any other utility bill indicating the address of the applicant.
(h) A Certificate of residence issued by the Panchayat, Municipality, Cantonment Board, any gazetted officer, or the concerned parwari or Head Master of a Govt. School.
(i) ln'case of an inmate of a residential institution for persons with Disabilities, destitute, _ mentally ill, etc. A certificate of residence from the head of such institute.
2. Four recent photographs (2 passport size & stamp size) ............................................
gFor office use only) Date:
Place:
Signature of the issuing authority Stamp .....................
IS Purl en 11 Details 9| Aflfiggmgnt (For use of the Met lenl Board ) Name of the applicant: ................. .‘. . n . . ................................
i) Locomotor Disability (LD)
1. The case ofthc applicant is ............... . . . . . . ............ - ....................
2. Nature of Disability .................... . . .In relation to his/her ...................
3. Degree/ Percentage ofdisability ............ . ...................................
'4. His [her condition is progressive/non-progrcsslvo/Ilkcly to improve/not likely to improve.
5. Re- assessment is not recommended/is recommended after a period of .......... month/year.
Signature of Specialist/Doctor.
( Seal) ii) Hearing Impairment (HL
1. The case of the applicant is .....................................................
2. Nature of Disability .................... in relation to his/her .......................
3. Degree/ Percentage of disability ........... . ....................................
4. His /hcr condition is progressive/non-progressivc/likely to improve/not likely to improve.
5. Re- assessment is not rccommended/is recommended after a period of .......... month/year.
Signature of Specialist/Doctor.
( Seal) iii) Visual Inlpairmcnt (VI)
1. Thecase of the applicant is .....................................................
’2. Nature of Disability .................... in relation to his/her ......................
3. Degree/ Percentage of disability ...................................... '..........
4. His /her condition is progressive/non-progressivc/likely to improve/not likely to improve.
5. Re- assessment is not recommended/is recommended after a period of .......... month/year.
Signature of Specialist/Doctor.
( Seal ) 16 iv) Mental Retardation/Mental IllnessM
1. The case of the applicant is .-.--.a-. - ...........................................2. Nature of Disability .................... in relation to his/hcr ......................3. Degree/ Percentage ofdisability ........... -------------------------------------4. His /her condition is progressive/non-progressive/likely to improve/not likely to improve.5. Re- assessment is not recommended/is recommended after a period sf .......... month/year.
Signature of Specialist/Doctor.
( Seal ) PSYCHOLOGICAL ASSESSMENT REPORT
1. Date ofAssessment :- ..............2 Date of Birth . ..............3 Age .......4. Sex ..........................
5 Test Administered.......................
6. I. Q. Score / Disability Score ................................................
7. Level of Disability ........................................
8. Degree/ % of Disability :— . Remarks :- uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu \ 0 (Signature ofthe Psychologist) ( Seal )i v) Multiple Disabilities
1. The case ofthe applicant is
2. Nature of Disability in relation to his/her ............................................... y............3. Degree/ Percentage ofdisability ................................................
Calculation for the total percentage of MD:- a+b(90-a) 90 l7 Form - 2Farm No. ...............................
[see sub-rule (2) ofrule 4 and sub-rule (7) ofrule 6] GOVERNMENT OF MANIPUR OFFICE OF THE DEPUTY COMMISSIONER: Paste one ..................'............... DISTRICT Password photo “* and affix 2 extra (Application Form for Selection of Beneficiary under NFSA, 2013) duly attested.
Desh RC DModification (RC No. ..........................................................) (3-5 cm X 2.5 cm) Particulars ofHead ofHouse]:old:
Name: .............................................................................................................................................................
(Eldest Women member ofthe family) Cl), W/O, D/O .................................................................................
Type of Card Applied (Please Tick Q: E] AAY D PRIORITY Resident Address: .........................................................................................................................................
VillagelTown (As per RGI): ................................................ Sub-Dlvision .......................................................
District: ............................................................................................... PIN: ..................................................
Professional Details (Occupation): .............................................................................................. '. .................
Annual Income in Rs. ..................... (In words) ....................................................................................
“ AADHAAR NO./UID "‘ PHONE NO. :- Enclosures. Please tick (you can select maximum of 3 Document):
1. [birth Certificate 2. C] Domicile CertlflcateS. Drivlndjcense
4. Dilater ID 5. [jofflce ID 6. DMoblle Bill 7. [jtome Certificate Bank details: Name of Bank & Branch: ..........................................................
Bank Account No. ...................................................................................
Household details (including Head of Family):
N Name in BLOCK LETTER Sex Date of Birth with head 1 SELF 2 3 4 5 6 7 8 9 .
10 , ' UNDERTAKING .
l, ..........................(Name of the applicant) declare that the particulars of myself and my family members fumished herein above are true and correct and nothing has been concealed therin. I shall be held responsible for finishing the above information, if it is false in any materials particulars and if there is reasonable cause to believe it to be false, or in not believe it‘to be false, or in not believed to be true by the Authority and thereby become liable for prosecution under section — 7 read with section — 9 ofthe essential Commodities Act 1955 (Act 10 of 1955).
Date:
Place:
a0..
o0.0 Signature/ Left Thumb Impression of the Applicant 1f the eldest women member isles than 18 (eighteen) years of age, then male member will be the head of the family.
The undertaking shall be attested by an Executive Magistrate.
10.
11.
3. Address (21) House No.
s o s o s n e 18 Form-3 [See sub—rule (2) of rule 8] PROFORMA FOR LODGING COMPLAINTS/GRIEVAN CES UNDER THE MANIPUR‘FOOD SECURITY RULES, 2016 . Name Contract No. (Mobile/Landline No.) :
(b) Village/Locality
(c) Town/District
(d) Pin Code Ration Card No.
Name ofFair Price Shop Complaint registered with Complaint registered against Details of Complaint (can attach a separate sheet) Documents enclosed in support of the Complaint Whether the complaint was lodged earlier also? Yes [:i if yes, what was the action taken? Give details:
(a) Date No
(b) Complaint registration number
(c) To whom the complaint was registered:
(d) Against whom the complaint was registered):
19 I hereby declare that all the information stated in the complaint is true to the best ofmy knowledge. ' Date: Signature of the Complainant it"llilli'lllhlllhii‘llllk ACKNOWLEDGENIENTRECEIPTOF CONIPLAINT/GRIEVANCES UNDERTHE MANIPUR FOOD SECURITY RULES. 2016 Number: Date: __ Received complaint from :
Complaint received by:
Name of the Officer: Designation:
Office Seal Signature ofthe Officer:
Printed at the Directorate of Printing & Stationery, Government of Manipur/265-C/28-02—2019.