(1) Every order under these rules, shall be dated, signed and communicated to all the parties.
(2) All sums realised by way of penalties under the Act shall be credited to the Environmental Relief Fund.’’.
9. For Form I and II in the said rules, the following Schedules shall be substituted, namely: - THE FIRST SCHEDULE FORM I [See rule 3(1)] FORM OF APPLICATION FOR RELIEF OR RESTORATION OF PROPERTY Date:
Mr/Ms/Mrs.* ________________________________________________ Son of/ daughter of/ Widow* of Mr. _________________________________________ died/had sustained- injuries in an accident on ________________________________ Other information are given below: -
1. Applicant Information:
(i) Name of the Applicant:
(ii) Father's name:
(iii) Address:
(iv) City: State: Zip:
(v) Contact No.:
2. Affected Party information:
(i) Name:
[भ II—ण 3(i)] भ : अ 17
(ii) Father’s Name:
(iii) Sex of the person injured/dead/affected:
(iv) Nature of injuries sustained:
(v) Occupation of the person injured/dead:
(vi) Relationship with applicant:
(vii) Address:
(viii) City: State: Zip:
3. Details of Accident:
(i) Date of Accident:
(ii) Time of Accident:
(iii)Location of Accident:
(iv) Type of Accident: (tick the following) [ ] Damage to private property from an accident [ ] Death or Injury to any person (other than workman)
4. Estimated financial loss (if applicable):
5. Description of accident and damage:
______________________________________________________________________________________ ______________________________________________________________________________________ ____________________________
6. List of relevant documents attached:
(i) Medical certificate in case of death, injury or disability
(ii) Damage to property claimed
(iii) Proof of employment and wages received in case of wage loss
(iv) Any other document.
7. Additional Information:
(i) Name and address of police station in whose jurisdiction accident took place or was registered:
(ii) Name and address of the registered medical practitioner who attended on the injured or dead:
(iii) Any other information that may be considered necessary or helpful in the disposal of the claim:
I hereby swear and affirm that all the facts noted above are true to the best of my knowledge and belief.
SIGNATURE OF THE APPLICANT/CLAIMANT Date:________ Place:________ ----------------------------------------------------------------- * Strike out whichever is not applicable 18 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] FORM II [See rule 3A(1)] FORM OF APPLICATION FOR ALLOCATION OF FUNDS FROM ENVIRONMENTAL RELIEF FUND Mr./Mrs./Miss _______________________ on behalf of Central Pollution Control Board / the State Pollution Control Board, [CPCB/SPCB], hereby submit an application for the allocation of funds from the Environmental Relief Fund (ERF) established under section 7A of the Public Liability Insurance Act, 1991.
The details of the application are provided below:
1. Details:
(i) Name of [CPCB/SPCB]: _______________________________________________
(ii) Address: ____________________________________________________________
(iii) Contact person: ______________________________________________________
(iv) Contact number: _____________________________________________________
(v) Email address:_______________________________________________________
2. Purpose of allocation:
____________________________________________________________________________________ ______________________________________________________________ _________________________________________________________________________
3. Assessed environmental damage: ____________________________________________
4. Estimated fund requirement:
(i)Total estimated fund requirement: ______________________________________
(ii)Breakdown of fund utilization: _________________________________________ ___________________________________________________________________
5. List of relevant documents attached:
6. Additional information:
(i) Name of the Unit/Units with detail of owner/owners: __________________________
(ii)Name of chemical manufactured/ handled by the unit/units causing accident: __ ___________________________________________________________________
(iii) Address and co-ordinates of the Site: _____________________________________
(iv) Place, date and time of Accident: ________________________________________
(v) State Pollution Control Board in whose Jurisdiction environmental damage took place or was registered: _______________________________________________________________
(vi) Any other information: _________________________________________________ I hereby declare that the information provided in this application is accurate to the best of my knowledge.
Date:_____ Place:_______ [Signature] [Name] [Designation] [Organization Name] [भ II—ण 3(i)] भ : अ 19 FORM-III [See rule 3A(2)] Application No.
Date:
SANCTION ORDER I hereby sanction Rs. ………. From the Environmental Relief Fund for restoration of environmental damage at the place/unit/locality…… to the Central Pollution Control Board/ State Pollution Control Board …….. in reference to the application No…….. submitted by them.
Signature of the Concerned Authroized Officer Copy to:
1. Fund Manager
2. Office of CPCB/SPCB.
FORM IV FORM OF NOTICE [See rule 9] By Registered post acknowledgement due From* _____________________ _____________________ _____________________ To, _____________________ _____________________ _____________________ Notice under clause (b) of Section 18 of the Public Liabilty Insurance Act, 1991;
Whereas it appears to me/us that an offence under the public Liability Insurance Act, 1991 (6 of 1991) has been committed/ is being committed by** ___________________________ ___________________________ ___________________________ ___________________________ I/We hereby give notice of sixty days under clause (b) of section 18 of the Public Liability Insurance Act, 1991 of my/our intention to file a complaint in the court against ___________________________ ___________________________ ___________________________ ___________________________ for violation of section of the Public Liability Insurance Act,1991.
20 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] I/We, in support of this notice, hereby enclose the following documents *** evidence of proof of violation of the Public Liability Insurance Act,1991 :- Place _________ Date ___________ Signature ___________ * In case the notice is given in the name of the company, documentary evidence authorising the person to sign the notice shall be enclosed to this notice.
** here give the name and address of the alleged offender. In case of handling/ manufacturing/ processing/ operating unit indicate the name of the unit/location and nature of activity, *** Documentary evidence includes, photographs technical report/health reports of the area;
relating to the alleged violation/offence.
FORM V [See rule 12] To, The Adjudication Officer …………………
1.Particulars of complainant: -
(a) Name:
(b) Address for service:
(c) Contact No:
(d) Email (for service):
2. Particulars of complaint: -
(a) Date, time and instance of commission of the alleged contravention:
(b) Statement of contravention setting out all relevant material particulars:
(c) Evidence in support of the statement:
(d) Tentative amount of damage (in pecuniary terms) with cost break-up.
I/We………., the complainant………………herein declare that the facts stated herein are correct to the best of my/our knowledge.
3. Name and Signature of the Complainant:
Note. – Strike out whichever is not applicable.
[भ II—ण 3(i)] भ : अ 21 Form –VI [See rule 13(1)] To ----------------------------------- ----------------------------------- ----------------------------------- SHOW CAUSE NOTICE Sub: Contravention of the Public Liability Insurance Act, 1991.
Sir/Madam, As per the complaint received on dated __________(copy enclosed), contravention has been committed under section ------------------------ of the Public Liability Insurance Act, 1991 in…………………………………………………………..…………………………………
2. The above contravention is liable for penalty.
3. Therefore, you are required to show cause within a period of ------ days of service of this notice, why an inquiry should not be initiated against you under the Public Liability Insurance Act, 1991 for imposition of penalty. In case, no reply is received within the given period, the further action shall be taken under the Act .
Date___________ Place___________ Adjudicating Officer (Name and seal of the office) FORM-VII [See rule 13(5)] Furnishing of document or evidence by or on behalf of the contravener To Adjudication Officer ………………… ………………….
………………….
1. I/We, ……………………………….……………….
……………………………………………………….
……………………………………………………….
hereby give a counter statement to the complaint made in Form-I The grounds in which the counter statement is made are as follows: - ………………………………………………………… …………………………………………………………
2. Complete address including postal index number/code and state along with mobile number and e-mail.
3. Signature of the contravener or his authorised representative:
4. Name of the person along with mobile number who has signed.
22 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] THE SECOND SCHEDULE [See rule 10(5)] Reimbursement of medical expenses incurred in each case and other reliefs shall be as follows:-
(a) death due to fatal accidents, the relief will be Rs. 5,00,000/- per person in addition to reimbursement of medical expenses, if any, incurred on the person up to a maximum of Rs.
1,50,000/-;
(b) permanent total or permanent partial disability, the relief will be -
(i) reimbursement of medical expenses incurred, if any, up to a maximum of Rs. 25,000/- in each case; and
(ii) cash relief on the basis of percentage of disablement as certified by a registered medical practitioner in case of total permanent disability will be Rs. 5,00,000/-;
(c) loss of wages due to temporary partial disability which reduces the earning capacity of the victim, a fixed monthly relief will be actual amount not exceeding Rs. 25,000/- per month up to a maximum of 3 months in case the victim has been hospitalised for a period exceeding 3 days and is above 16 years of age;
(d) damage to private property, relief will be an amount not exceeding Rs. 50,00,000/- depending on the actual damage in each case.
(e) other injury or sickness, reimbursement of amount not exceeding Rs. 25,000/- of actual amount in each case.’’.
[F. No. HSM-12/96/2020-HSM] VED PRAKASH MISHRA, Jt .Secy.
Note: The Principal rules were published vide S.O.330 (E) dated 1st May, 1991 and amended subsequently vide G.S.R. No. 596 (E) dated 20th September, 1991, G.S.R. No. 87 (E) dated 6th February 1992 and G.S.R.
No. 391 (E) dated 23rd April 1993.
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.
GORAKHA NATH YADAVA Digitally signed by GORAKHA NATH YADAVA Date: 2024.12.18 12:14:42 +05'30'