HRD in CBEC - Directorate General of human resource ...

CERTIFICATE
78
(Proforma)
(To be submitted with the proposal for grant of Financial
Assistance on non reimbursable medical claims)
1. Certified that the proposal for financial assistance has been
recommended by the Advisory Committee constituted in this
office for this purpose.
2. Certified that a sum of Rs._____has been earlier sanctioned to
the individual as Financial Assistance from the Welfare Fund
for medical expenses for spouse and dependent children and
the details thereof have been entered in the individual’s service
book. Further,______ number of proposals of Financial
Assistance are pending (give details) with Directorate of
Logistics.
Note: The amount of financial assistance to staff/employee
should not be included in above certificate
3. Certified that the name of the officer is as per the service book
(in case of change of name, details may be given.)
4. Certified that the number of surviving children are less then two.
Note: This certificates required only in cases of grant of
Financial Assistance on the non reimbursable expenses
on the maternity expenses or termination of pregnancy.
5. Certified that the spouse of employee/officer is non working.
Note: This certificate is required only where financial
assistance is sought for medical expenses of spouse.
6. Details of medical expenses reimbursed and not reimbursed
are as under:
No. of days for which room rent paid for stay in other than
ICU/CCU ________