This Agreement Made This

APPENDIX-I

1 Name and address of the limestone and dolomite mine.
2 No. of workers and their families to be benefited in the proposed scheme.
3 Extent of mechanization.
4 Distance from housing colony to the nearest hospital.
5 The distance between the general hospital to the mine hospital / dispensary
6 Month-wise production for last three years.
7 Total cess paid for the last 3 years (year-wise figures).
8 Total cost of ambulance van proposed to be purchased.
9 Other relevant particulars justifying for the purchases of ambulance van.

APPENDIX – II

STAMP

Agreement between ------

------

And

President of India

This agreement made this------

------

Day of ------one thousand nine hundred ninety ------

------

------Between------

------

------Ltd., a limestone / dolomite mines company recognized under the

companies Act. 1956 /

(1) ------(2)------

------

(3)------Partners / proprietors of------

------of limestone / dolomite mines and having its

registered

Office at ------

Carrying in business under the firm and style of ------

------at------in the town of ------

------and having its /------

------Of the state of------

hereinafter referred to as the applicant / the applicant which terms shall unless excluded by or repugnant to the subject or context include (its successor and permitted assign) (all partners of the said firm and their respective heirs, executors, administrators and the permitted assign of the said partners ) of the one part and the president of India (hereinafter called the “government” which terms shall unless excluded by or repugnant to the subject or context include it successors and assign) of the other part.

WHEREAS the “Application / the application” has / have applied for sanction of grant-in- aid under rule 37 of the limestone and dolomite mines labour welfare fund rules 1973 and the “Government” have sanctioned Rs ------

------(Rupees------)

only as subsidy for purchases of the following equipments for improving this dispensary

at------

(2)

Maintained for their limestone miners and their dependants vide letter No.------

Of government of India ministry of labour, New Delhi

ITEMS COST

Now this indenture witness as follows:

1 The payment of the above grant-in-aid shall be subject to the

following conditions.

(a) That the work or which the grant is made is duty and promptly

executed and the money is actually utilized for the purpose for

which it is granted.

(b) That the date on which the grant is calculated are in accordance

with facts

time require for the proper discharge of this responsibilities are

promptly supplied

(d) That all necessary facilities for inspection are accorded to persons duly

authorized by the central government for the purpose of clause (A) or

for checking the correctness of any particulars supplied under clause

(e) That proper accounts of the money granted are kept and are submitted

for audit by such persons as the central government may authorized in

this behalf

(f) That an additional statement of accounts together with a certificate of a

registered accountant or other recognized body of auditors to the effect

that the accounts are correct, is furnished by the grantee.

(g) The agreement shall remain in force until the ambulance van is

declared unfit for use by the regional transport authority.

(h) The management shall send an annual certificate on of before 15th of January every

year to the effect that the van is being utilized as ambulance for the welfare of the

mine workers. A proper log book is being maintained until the van is declared unfit

2 The fund shall be released in one lump sum and the money shall be

utilizedfor the aforesaid purpose within one month of the released of

the fund as stipulated (1) above

3 In the event of violation of any condition imposed under (1) above, the

applicant owner shall be liable to pay central government a sum of Rs.----

------(Rupees ------)

By way of interest @ 14% per annum in addition to refund of the entire

remaining grant-in-aid

IN WITNESS WHEREOF the parties hereto have signed this deed on the day and year first above written.

EXECUTED BY Shri------

Welfare commissioner, beedi workers welfare fund / iron ore / manganese ore / chrome ore mines labour welfare fund / mica mines labour fund / limestone and dolomite mines labour welfare fund for and on behalf to the president of India in the presence of ------

In case of companies only. COMMON DEAL FO M / S------

______

Affixed under resolution of the board of directors dated ------

Affixed in the presence of Shri ------

------Director and Shri ------

Secretary of the company

CHECK-LIST FOR PROPOSAL TO THE MINISTRY FOR SANCTION OF GRANT IN AID IN FAVOUR OF THE MINE MANAGEMENTS FOR PURCHASE OF AMBULANCE VAN

1. Name and address of the mine management
2 Name and location of the dispensary / hospital maintained by the mine management for the benefit of their mine workers
3 No. of mine workers / factory
workers and other local people (including family members) who are allowed treatment from hospital / dispensary
4 No. of mine workers / factory workers and other local people (including family members) treated in the dispensary during three years preceding the year in which proposal is made
5 Whether treatment charges are received on treatment of non mines, if so, proceeding the year in which proposal is made
6 Name of the items proposed to be purchased
7 Cost of the items proposed to be purchased
8 Copy of quotation to indicate the cost of items in duplicate.
9 Cess paid by the mine management in each of the year during 3 years preceding the year in which proposal is made
10 Grant-in-aid received by the mine management in each of the year during the three year preceding the year in which proposal is made (please mention scheme wise and year wise).
11 A copy of the inspection report of the dispensary / hospital maintained by the mine management for the year preceding the year in which proposal is made.
12 A copy of agenda and minutes of the S. A. C. meeting in which proposal has been recommended by S. A. C.
13 Sanction budget grant under the head “Health-grant-in-aid” during the financial year (including provision made in R. E. also in case at the time of submission of proposal.)
14 Expenditure incurred out of the sanctioned budget grant / proposed R. E. under the “Grant-in-aid” at the time of sending the proposal.
15 Expenditure committed under the head “Health-Grant-In-Aid” as on the date of submission of
this proposal (indicate item wise.)
16 Balance in hand to meet the expenditure inter-alias for the proposal being sent to the ministry.
17 Proposed manner of spending the balance provision (indicate item wise.)
18 Rules / scheme under which the proposal is covered.
(1) Whether the mine management already has ambulance van (s)
(2) Were these purchased by Grant-In-Aid from L.W.O.?
(3) If yes, give reason as to why the management needs another ambulance vans and why grant in aid should be given by L.W.O
19 Whether the management already has in the dispensary / hospital the equipments for which grant-in-aid is being proposed (2) were these purchased by grant-in-aid from L.W.O (3) if yes, give reasons, as to why the management further needs the equipments and why grant-in-aid should be given by labour welfare organization.
20 (1) List of other request from mine management for grant-in-aid for purchase of ambulance van / equipments pending with welfare commissioner indicating date of receipt.
(2) In case this proposal has been submitted out of turn (indicate reason in detail

APPLICATION FOR AMBULANCE VAN

1 Name and address of the limestone and dolomite mines

2 No. of workers and their families to be benefit in the proposed

scheme.

(a) Mines workers.

(b) Factory workers.

3 Extent of mechanization

4 Distance from housing colony to the nearest Hospitals

5 Name and location of dispensary / hospitals maintained by mines

management for mines workers.

6 The distance between the state general hospital to the mine

hospitals / dispensary.

7 Whether treatment charges received on the treatment of non

mines. If so amount received during last 3 years/

8 (a) whether the mine management already has ambulance van

(b) Were there purchased by grant-in-aid from welfare organization.

(c)If yes, give reasons for replacement.

9 Total percentage of mine workers treated during the preceding years from the total patients treated.

10 Month wise production for last 3 years.

11 Total cess paid for the last 3 years (year wise figure).

12 Total cost of ambulance van proposed to be purchased.

13 Other relevant particular justifying for the purchase of

ambulance van.