WELFARE OFFICER’S REPORT

The undersigned visited personally the residence of deceased Govt. Servant on

…………… … as per official orders and verified the family particulars & other details
which are given below.

1. (i) Name of the deceased Govt. Servant : Late Shri Ashok B.Jogawade
(ii) Designation : Mate
(iii) Date of Birth : 19/3/1958
(iv) Date of Death : 24/9/2009
(v) Date of joining Govt. Service. : 1/5/1976
(vi) Length of Service rendered : 22yrs 7months 26days

2. Family Particulars

S.No. Name of Dependent Date of Age Relation Educational Married

family member Birth (in years) -ship Qualification Unmarried/Wido
w
1 Mrs.Jayshree -- 45 Yrs. Wife illiterate Widow.
Ashok Jogawade
2 Kunal Ashok 29/11/1982 27 Yrs. Son VIIth Married
Jogawade

(b) Employment status/Monthly income of dependent family member as mentioned above with
employer details:

S.No. Name of the dependent Name of Employer Monthly income Rs.

family
1 Mrs.Jayshree Ashok Not employed Nil
Jogawade
2 Kunal Ashok Jogawade Pvt. shop 4000/-
Details of Immovable properties :

( All column must be filled as YES or NIL)

3.A
1 No Immovable property Yes
(i.e.House/Housing plot/Land)
Kacha Housing /Housing Plot No
2 (<750 Sq ft.)
Concrete House/Housing plot No
3 (< 750 Sq Ft.)
Kachha/ Concrete House/ Housing plot No
4 (> 750 Sq Ft.)
Land No
5 (<1000 Sq Ft without House/Housing Plot)
Land No
6 (<1000 Sq Ft with Kachha House/Housing Plot < 750 Sq Ft.)
Land No
7 (<1000 Sq Ft with Concrete House/Housing Plot < 750 Sq Ft.)
Land No
8 (>1000 Sq Ft with House/Housing Plot > 750 Sq Ft.)

(B) (i) Movable Assets Vehicle particulars giving its model, date of purchase.
Owner’s identity & its cost.

Honda motor-cycle 2010 Rs. 35000/-

(ii) Details of any other movable assets.

NIL

4. Terminal Benefits received

(a) Family Pension : Rs. 4,415/-
(b) DCRG : Rs. 2,23,315/-
(c) GPF : Rs. 28,174/-
(d) DLIS : ---
(e) CGEIS : Rs. 15,000/-
(f) Leave Encashment : Rs. 12,709/-
(g) PLI :
(h) Any other benefits :
5. Particulars of Liabilities.

(a) Marriage of dependent family members.

No

(b) Education of dependent children.

No

(c) Medical treatment of dependent family member.

(1) Continuous Medical treatment to Smt.J.A.Jogawade @ Rs. 1,000/- per month

(d) Any other liabilities.

Inerest free loan of Rs. 1,50,000/-taken from relative for daughter
marriage Ku. Gauri A. Jogawade during April 2008 is still
outstanding.

6. Specific recommendation of Welfare Officer giving reasons for recommending the case
for compassionate appointment, after taking into consideration of details given in paras 2 to 5
above.

It is certified that particulars given above are factually correct as per official records and
on the particulars given by the family of the deceased and self-assessment made by the
undersigned during spot visit to the family.

Signature of the Welfare Officer)

Name of the Welfare Officer.
(SHRI P.N. MOHANAN)

Designation : SCIENTIST ‘E’

Office: O/O DDGM (SI) PUNE

Date: 16th December 2014