FORM ESWS/2

APPLICATION FOR SEMSO 1. 2. 3. 4. 5.

6.

Name of ESWS Member/Beneficiary ………………………………………………………………. School ………………………………………………………………………………………………. Dzongkhag ………………………………………………………………………………………….. ESWS Membership No……………………………………………………………………………… Semso availed for (tick the relevant one) Death of Spouse Name……………………………………………………….Citizenship I.D No…………………… Death of child Name………………………………………………………………………………………………... Age…………………………………………………………Citizenship I.D No…………………… Death of Parent Name………………………………………………………..( Mention Father/Mother ) Citizenship I.D No………………………………………………………………………………….. Death of member Name………………………………………………………..Citizenship I.D No………………….. Documents enclosed: Gup’s Death Verification Certificate with the Birth and Death Register No., verified by the Dzongkhag Administration Death Certificate from the Hospital in the prescribed Form issued by the Hospital I hereby declare that all the information provided here is true and accurate. Date: ________________________________ Signature of Applicant

Verification by Head Teacher I hereby declare that information provided by the applicant is true to the best of my knowledge. Name : …………………………………………………………………………………………… Date : ………………………………………………Signature : ……………………………….. Verification by DEO I hereby declare that information provided by the applicant is true to the best of my knowledge. The application has been duly noted in the Dzongkhag ESWS file. Name : ………………………………………………………………………………………………. Date : …………………………………………..Signature : ………………………………………….

FORM ESWS/1.0

DECLARATION OF MEMBERSHIP FORM The Chairman Education Staff Welfare Scheme P.O Box 835 Thimphu

Sir, DECLARATION OF MEMBERSHIP FORM 1.

I, Mr./Mrs./Ms………………………………………………………………RCSC Employee I.D. No……………………………………, do hereby declare that I have read and understood the rules and regulations of the ESWS as outlined in its bye-laws. Having read these, I wish to become a registered member of the ESWS.

2.

I do also hereby declare that once I become a registered member of the ESWS, I shall abide by the rules and regulations of the ESWS as well as any amendments to these rules and regulations which may come into effect from time to time. In case I am found guilty of breaking the rules and regulations, I shall abide by the decision of the ESWS Managing Committee.

3.

I hereby authorise the ESWS to deduct my monthly contributions and loan recoveries from my salary as described in the ESWS bye-laws.

Present Address:

Home Address:

……………………………………….

Citizenship I.D No: (copy attached) House No: Village: Gewog: Dzongkhag:

………………………………………. ………………………………………. ………………………………………. ……………………………………….

Date of Birth: Date & Year of Joining as Member: Name of School/Institute/Organization (at least two or three): **

Submission Date: (SIGNATURE) (For Office use only) Mr./Mrs./Miss. ……………………………………………………… is hereby registered as a member of the ESWS with effect from…………………………..He/she has been allocated Registration No. ………….

** Note: To find out your contributions.

FORM ESWS/2.0

DECLARATION OF DEPENDENTS FORM 1.

I, Mr./Mrs./Ms…..……………………………………………………………………… do hereby declare that names mentioned below are my living dependents:

a.

Spouse:……………………………………………. Date of Birth: Citizenship I.D No: Marriage Certificate No:

b.

Children:

Date of Birth:…………………… Date of Birth:……………………. Date of Birth:……………………. Date of Birth:……………………. Date of Birth:……………………. Date of Birth:…………………….

c.

Father Name: Citizenship I.D No:………………………

Date of Birth:…………………….

d.

Mother Name: Citizenship I.D No:………………………

Date of Birth:……………………

2.

I attach herewith copies of national ID cards of all my dependents mentioned above:

3.

In the event of their demise, benefits, as defined in the ESWS bye-laws, may be given to me.

4.

I hereby nominate and confer on Mr./Mrs./Ms. ………………………………………………the right to receive the entire amount that may be payable to me by the ESWS in the event to my death. I hereby declare that all the information given above are correct.

Submission Date: ……………………………

(SIGNATURE)

Verified by: ………………………………………………………………………………. (Head Teacher / Head Master / Principal) Verified by : ………………………………………………………………………………. (Dzongkhag Education Officer)

Verified by: …………………………………………………………………………(Director, AFD, MoE)

Education Staff Welfare Scheme : Loan Application Form Application date : ……./……/…….. 1. Name : 2. CID No (attach copy) : 3. Emp.ID No : 4. Designation : 5. Current working Address : 6. Member since :……/……/……. 7. Loan requested for : 8. State if you’ve any loan with Financial Institutions (attach certificate): Yes/No 9. Amount applied for : Nu………………. (In words:……………………………………..) 10. Last month’s net take home pay :……………….(Please attach the last month’s pay slip) 11. E-mail address/Contact no :………………………………………………….

I confirm that particulars mentioned by me are correct to the best of my knowledge and having understood the terms & conditions of ESWS would like to avail the above loan.

Signature (applicant)

Verification by: I hereby declare that information provided by the applicant is true to the best of my knowledge and the application has been duly noted in the ESWS file.

1. Name:………………………………..Date:…………Signature………………......DEO/ADEO 2. Name:…………………………..........Date…………Signature………………….PRINCIPAL 3. Name:………………………………..Date………….Signature……………….....HEAD(HQ) 4. Name:………………………………...Date…………Signature……………...HEAD(Institute)

…………………………………(This section for official use)………………………………….. Recommended/Not recommended for loan (state justification)

Manager

Date :……./……../……… Undertaking Letter

To Education Staff Welfare Scheme Ministry of Education Thimphu

Mr/Mrs/Miss…………………………………………Emp.ID…………………………………….. and CID.No…………………………….a teacher/staff/ of ………………………….has applied for a loan from the ESWS scheme for the purpose of………………………………...If the loan is sanctioned, I hereby undertake to deduct the monthly installment from his/her salary and remit it to the ESWS until the loan is fully liquidated. In the event of the employee being suspended of resigning or being terminated from the service, we hereby undertake to recover the loan outstanding from his/her accumulated Provident Fund. In case of transfer of the employee, we shall inform the concerned Dzongkhag/department to deduct the monthly installment and remit it to the ESWS scheme without fail.

Seal

Accounts Officer

Name………………………………. Signature………………….

Tel. No. 21242/22893 26412/24826

EDUCATION STAFF WELFARE SCHEME MINISTRY OF EDUCATION Thimphu : Bhutan

Fax No.325327 Post Box No. 112

Date….../…../……...

LOAN AGREEMENT

The ESWS Secretariat has sanctioned the sum of Nu. 50,000/-( Fifty Thousand only ) to the Borrower, Mr/Ms…………………………………….holding Emp.ID………………….and CID No…………………………Designation:………………………………………….School/Hq/Instit ute/others:……………………………………..,Dzongkhag:…………………............by way of Welfare loan to be recovered as monthly installment from his/her monthly salary. The Borrower agreed to abide by the following conditions:

i)

That the loan will be repaid by the borrower with interest by monthly installment of Nu…………each to which it relates together on the said sum of Nu. 50,000/- of such part thereof as shall for the time being remain due and owing to ESWS @ 5% p.a.

ii)

The Borrower, having understood the Terms & Condition have agreed to mortgage its Provident Fund against the above loan availed.

iii)

The Borrower agree that the ESWS may take such action as it may deem necessary to realize the ESWS due should there be default in effecting the payment due to the ESWS as stated above. In case of termination or resigned from the service, ESWS is hereby authorized to recover the amount out of the Provident Fund payable to the borrower. In case of death the outstanding loan will be written off.

Witness: Need to be a member of ESWS *** (Signature of Borrower) affix Legal Stamp Nu.10

Signature:……………………….. Name:…………………………… CID.no………………………….. Address………………………….

Welfare Loans Modality 1.

2. 3. 4. 5. 6. 7. 8. 9.

Maximum ceiling of Nu.50,000 Interest for the loan @ 5% Recovery on a monthly installment basis and deducted at source Liquidation of loan to be completed in 3 years/2 years or 1 year Provident Fund as mortgage Loan to be disbursed only from the ESWS Headquarter Such loan to be made available once Loan to be approved by the ESWS chairman Undertaking Letter Conditions

1. Justification for applying loan a) Children Education b) Repayment/Liquidation of Loan c) Partial construction/Repairing of House d) Partial Purchase of Land 2. 3. 4. 5. 6. 7. 8.

Medical Emergency (seniority clause shall not be applicable) Minimum of 5 years from superannuation Seniority basis Needs to be a member for a minimum of 7 years Client of other financial institution or not Undertaking Letter Capacity to repay the ESWS Welfare loan a) Minimum Net take home pay of Nu.4000 9. Verified by DEO/Headteacher, Head of Institutes, Head of AFD 10. Availability of fund