Checklist for processing application for appointmen t on Compassionate ground in terms of Labour
Department Notification No. 251-Emp dated 3rd Decemnber, 2013 read with Notification No. 26-Emp
dated 01/03/2016 and No. 4097/PN/O/III/2A-63/2014 dated 29/09/2014 of P&RD Department, Govt. of
WB
(A) Details of deceased/incapacitated employee
Name : Ramen Roy
Designation : Sahayak
Name & Address of Office : Dabgram-II Gram Panchayat (GP)
Date of death/incapacitation : 05-08-2024
(B) Details of the application and the applicant
Sl No Particulars Remarks
1(a) The Name of the Applicant : Laxmi Roy
Whether the applicant is a dependent family Yes
member of the deceased/permanentlty
1(b)
disabled/incapacitated employee
:
Relation with the Employee Wife
2 Application and Documents
Whether the proforma application (under
Annexure A) is preferred within the stipulated
2(a)
period as mentioned under clause 10 of the
: Yes
Notification [i.e. within 2 years]
Whether the Annexure A/B (as applicable) has
2(b) been duly filled in and preferred to the Head of : Yes
the Office
Whether (in case of death in harness) an
2(c) attested copy of death certificate of the : Yes
employee has been furnished
Whether the three-men screening-cum-Enquiry
3 Committee was constituted by the Appointing : Yes
Authority
Whether the information furnished in the
4 application were verified/checked by the three- : Yes
men committee
Whether the dependent family members as
5 well as the legal heirs of the employee were : Yes
identified
6 Family Income
6(a) Total Family Pension per month : Rs. 20,737/-
Total amount received after death (like
6(b) Gratuity, GI, Leave Encashment, Other Income : Rs. 12,25,302/-
excluding GPF
Medical Expenses incurred as indoor patient
6(c)
prior to and leading to death
: Nil
6(d) Monthly interest income - 8% of [6(b)-6(c)] : Rs. 8,169/-
6(e) Monthly income from properties : Nil
Monthly income of the dependents of the
6(f)
deceased/ incapacitated employee
: Nil
6(g) Any other income of the family as disclosed : No
Total Monthly income of the family of the
6(h)
deceased [6(a)+6(d)+6(e)+6(f)+6(g)]
: Rs. 28,906/-
Last Gross Monthly Salary drawn by the
6(i)
deceased
: Rs. 56,425/-
Whether the disclosed monthly family income
determined falls within the eligible/qualifying/
ceiling limit i.e. 90% of the gross monthly
6(j)
salary of the employee before death or
: Yes, 66.12%
premature retirement [whether 4(h)<90% of
4(i)]
Whether the monthly family income is below
6(k)
the minimum salary of a Gr. D/ Gr. C employee
: No
Additional eligibility criteria (Clause 6) in case
7
of premature retirement
Whether the employee had at least 2 years of
7(a)
service left before superannuation
: No
Whether eligible/getting to full pensionary
7(b)
benefits
: Yes
Whether the employee exhausted all kinds of
7(c) leave with pay including commuted leave on : No
Medical Grounds
Whether the pecuniary conditions of the family
is so acute as to make the appointment
7(d)
essential consequent upon the fall in income
: Yes
due to such premature retirement
8 General conditions/ Eligibility :
(i) D.O.B. of the applicant
15/05/1987
(ii) Age as on the date of
Whether the applicant is eligible and suitable
8(a)
for compassionate appointment for the post
: death of the employy
37 yrs 2 months 21 days
(iii) Educational Qualification
BA passed
Whether there is any requirement for age
8(b) condonation (by the Department or the : No
Appointing Authority, as the case may be)
Whether relaxation in educational qualification
8(c) is required (by the Department in consultation : No
with the FD)
Whether the applicant has attained the
8(d) minimum age for recruitment at the time of : Yes
death of the Employee
Whether the applicant has promised to look
9(a) after the other family members in case of : Yes
appointment on compassionate ground
Whether the other members have
9(b) recommended for compassionate appointment : NA
in favour of the applicant
Whether the applicant belongs to the
10
SC/ST/OBC/ Genl category
: SC
Whether the report of the screening/ three
men committee was submitted to the
11
appointing authority within the stipulated time
: Yes
(i.e. 3 months from the date of application)
Whether the application was recommended by
12
the screening committee
: Yes
Whether the appointing authority has
13 identified corresponding vacancy and : Yes
recommended the application while sponsoring
14 Views of Appointing Authority :
