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Delhi Development Authority

Personnel Branch –V

Set of Documents applying

for Appointment on
compassionate grounds
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INDEX
1. Format of written application to be 03
submitted by the widow/legal heir of
deceased employee.
(To be submitted duly diarized in the office of the
controlling officer/DDO of the deceased employee).

2. Instructions for controlling officer/DDO. 04-05

3. Annexure ‘A’ ( PART-A) 06-07

Performa regarding employment of
dependents of DDA employee dying
while in service/ retired on invalid
pension.

4. Annexure ‘B’ ( PART –B) 08

To be filled up by the controlling officer/ Branch Officer.

5. Annexure ‘C’ 09
Specimen of affidavit from the applicant.

6. Annexure ‘D’ 10
Specimen of No objections in shape of affidavit from
other legal heirs of deceased employee.

***********
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To
The __________________________________________(DDO/Controlling officer)

_____________________________________________

_____________________________________________

Sub: Request for appointment on compassionate grounds after the death of

Sh/Smt._________________________________son/wife/daughter of Late
Shri_____________________________________working as _________________ on
Temp./ Permanent/Regular/ W/C-Regular basis.
********************
Sir,
With due respect, I am to state that my father/mother /husband Late Sh/Smt._______
______________________son/wife of Shri______________________________________
working ________________________________in your Division/Office) had expired on
__________________.

2. I am submitting the following document and applying for appointment on

compassionate grounds duly attested by Notary Public/ Gazetted Offer.

(a) Form Part –A ( as per annexure ‘A’)

(b) Original Death Certificate.
(c) Copy of Death Notification.
(d) Copy of Ration Card duly attested showing the name of the applicant and deletion of
the name of the deceased.
(e) Affidavit ( as per specimen at Annexure ‘C’).
(f) Affidavit / No Objection certificate (as per specimen at Annexure ‘D”).
(g) Photocopies of documentary proof of date of birth, Educational Qualifications/ School
Leaving Certificates/ Birth certificate in respect of applicant and each legal heirs.
(h) Three Passport size Photographs of the applicant duly attested by the DDA/
Controlling Officer.
(i) Cast Certificate, ( in case of SC/ST/OBC category) .
(j) Disability Certificate issued by the Medical Board constituted by the Central or State
Govt. (in case of persons with Disability category).

Encls: As stated.

Yours faithfully

Signature of the applicant

Name of the applicant_____________________________________

(in capital Letters)
Son/wife/daughter of Late Sh.______________________________
Postal Address:__________________________________________
______________________________________________________
Permanent Address:______________________________________
______________________________________________________
______________________________________________________
Contact No.____________________________________________
(Telephone / Mobile No. if any)
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INSTRUCTIONS FOR CONTROLLING OFFICER/

DRAWING & DISBURSING OFFICER.
(Formalities to be completed by Controlling Officer/DDO.)

…………………………………………

Application in prescribed Form (Part A & B annexed as annexure „A‟ &

„B‟) seeking appointment duly recommended & completed be got
diarized and placed in a separate file with the following documents.
The documents should be checked and verified from the service book
by the DDA and a certificate to this effect that the contents of Form A &
B have been checked from the service book and found correct should
be recorded.

1. Original Death Certificate issued by Municipal Authorities or other

Competent Authority.

2. Copy of Death Notification showing the date of death & date of birth
of deceased employee issued by the Competent Authority.

3. Each & Every page of the photocopy of Service Book of the

deceased should be attested by DDO/Controlling Officer.

4. DDO/Controlling Officer should duly attest entry of Death Notification

as well as Paid Death Benefits in the Service Book.

5. Upto date service verification of the deceased by the Controlling

officer/Drawing & Disbursing Officer.

6. Copy of Ration Card duly attested showing the name of the

applicant and deletion of the deceased name.

7. Affidavit from the applicant on non-judicial stamp paper of Rs. 10/-

(as per specimen at “Annexure –C” duly attested by the 1st class
Magistrate or Notary Public.

8. Affidavit /No Objection certificate on non-judicial stamp paper of Rs.

10/- duly attested by the 1st class Magistrate or Notary Public from
major legal heirs in favour of applicant. (as per specimen at
“Annexure –D” ( Please note that every major legal heir will submit
separate No Objection certificate).

9. Photocopies of documentary proof of Date of Birth, Educational

Qualifications/School Leaving Certificate/ Birth Certificate duly issued
by the Municipal Authorities etc. in respect of applicant & each legal
heirs.( In case of illiterate family member, the date of birth can also be
declared through affidavit ( Annexure‟C‟).

10. Three Passport size photographs of the applicant duly attested by the
DDO/Controlling Officer.

11. In Case of SC/ST/OBC applicant, copy of Cast certificate issued by

the competent authority duly attested should be attached.
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12. If the applicant is Physically Handicapped, an attested copy of

certificate of disability issued by the Medical Board constituted
by the Central/State Government should be placed in the file.

Note:
1. Cases of Regular Staff are required to be sent to Dy. Director (P) V
directly, after completing all the codal formalities as mentioned above.
2. Cases of Work-Charged or Work Charged (Regular) Staff: to be routed
through Director (Estt.) Work-Charged after completing the requisite
codal formalities.

………………………….
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Annexure - A

PROFORMA REGARDING EMPLOYMENT OF DEPENDENTS OF

DDA EMPLOYEE DYING WHILE IN SERVICE/RETIRED ON
INVALID PENSION

PART A

Description
1(a) Name of DDA employee (Deceased/retired on
medical grounds.
(b) Designation of the DDA employee.
(c) Whether Permanent/Temporary/Regular/W/C-
Regular.
(d) Whether it is Group “D” or not?
(e) Department/Branch where the employee was
working at the time of death/retirement on
medical grounds.
(f) Date of death/retirement on medical grounds.
(g) Date of birth of deceased/retired employee.
(h) Age of DDA employee on the date of
death/retirement on medical grounds.
(i) Total length of service rendered.
(j) Whether the applicant belongs to SC/ST/OBC?
If yes, necessary certificate issued by competent
authority be enclosed.
II (a) Name of Applicant for Appointment on
Compassionate grounds.
(b) Applicant’s relation with DDA employee/retired on
medical grounds.
(c) Date of birth of the applicant with documentary
proof showing date of birth.
(d) Educational qualifications of the applicant
(Enclose attested copies of certificates).
(e) Whether any other dependent family member has
been appointed on compassionate grounds?
(If yes, give full details).
III Particulars of total assets left by the
deceased/retired DDA employees including
amount of :-

(a) Family Pension

(b) Death Retirement Gratuity
(c) GPF balance
(d) GIS
(e) Benevolent Fund
(f) Leave Encashment
(g) Life Insurance Policies(Postal Life
Insurance)
(h) P.A.I.P
(i) Movable/immovable properties and other
income earned there from by the family.
(j) Any other properties/assets

Total:-
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IV Brief particular of liabilities, if any.

V Particulars of all dependent family member of the
DDA employees/retired on medical grounds (If
some are employed, their income and whether they
are living together or separately)
S.NO. Name(s) Relationship Age Present Employed or
with the DDA residential not (if
employee address employed,
Particulars of
employment
and
emoluments)
(1) (2) (3) (4) (5) (6)
1
2
3
4
5

DECLARATION/UNDERTAKING
1. I_______________Wife/son/daughter of late ______________________resident of
___________________________________________________hereby declare that the
facts given by me above are, to the best of my knowledge, correct. If any of the facts
herein mentioned are found to be incorrect or false at a future date, my services may be
terminated.
2. I hereby also declare that I shall maintain property the other family members who were
dependent on the Govt. servant mentioned against 1(a) of Part A of this form and in case
it is proved at any time that the said family members are being neglected or not being
property maintained by me, my appointment may be terminated.

Signature of the applicant

This is to certify that Sh/Smt./Kumari______________________________________________

son/wife/daughter of Sh./Smt.__________________________________________________is the
legal heir of late Sh.___________________________________Designation______________________
(to be certified on the basis of declarations and documents) that the contents/particulars/
information given in Col. I & III of Form Part ‘A” have also been verified from the Service Book of
deceased /retired employee & found correct.

Signature of DDO/Br. Officer with Date:______________________________________________

Name & Designation( with rubber stamp)_____________________________________________
Address of the Office:____________________________________________________________
Telephone No.:___________________________________________

I have verified the facts mentioned above by the applicant & are correct.

Date:______________ Signature of Welfare Inspector

Name:__________________________________
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Annexure ‘B’
PART-B
(TO BE FILLED UP BY THE CONTROLLING OFFICER/ BRANCH OFFICER)
…………………………………..

I(a) Name of the candidate for

appointment
(b) His/her relationship with the DDA
employee.
(c) Residential Address & Telephone
/Mobile No.(if any) (with documentary
proof.)
(d) Age / date of Birth
(e) Educational qualification.
(f) Experience, if any
(g) Post for which employment is
proposed and whether it is Group ‘C’
or ‘D’
(h) Whether the applicant fulfills the
conditions/ requirement of the post?
II Whether the facts mentioned in Form
Part-A have been verified and if so,
indicate the record.
III If the Government servant died/
retired on medical grounds more than
5 years back, why the case was not
sponsored earlier?
IV Personal Recommendations of Branch
Officer/ Controlling Officer/DDO

Signature of Br. Officer/Controlling Officer/DDO

( with date & rubber stamp)

Counter Signature of Competent authority

( with date & rubber stamp)
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Annexure- ‘C’
( This affidavit shall be given on non-judicial stamp paper of Rs. 10/- only duly
attested by Ist Class Magistrate or Notary Public)

Affidavit from applicant

I, _____________, wife/son/daughter of late Sh. ------------------, r/o House No.
_______________________________________________ do hereby solemnly affirm and declared as under:

2. That, I am the legally wedded wife/son/daughter of late Shri/Smt..___________, who was

working in DDA as ------ Temp./ Permanent / W/C (Regular)/Regular Estt. in the office of the
____________, New Delhi & expired on-----. The deceased had left behind the following legal
heirs/ Family members:

S.No. Name Age or Relation with marital status Educational Employed or un-
date of Qualification employed
deceased
birth
1.
2.
3.
4.
5.

3. That there are no legal heirs in the family except the members indicated in para 2 above.

4. That none of the family member including myself as mentioned above is in employment of any
Govt./Semi -Govt./ Private Service/ business
OR
That the legal heir(s) mentioned at S.No.________________above is/are employed/working
in______________(Name of organization/department).

5. That I have not re-married after the death of my husband (in case, the applicant is widow)

6. That I am applying for appointment on compassionate ground after the death or retirement on
medical grounds of my husband/father/mother Shri/Smt._________________& other legal heirs
have also given their NOCs in my favour.

7. That I am not in occupation of DDA Staff Qtr.

OR
That I am still in occupation of DDA Staff Qtr. No._________ at ________________, New Delhi.

Deponent
Verification:-
Verified at ____________ on this _____day of _________20 __ that the contents
mentioned above are true to the best of my knowledge and belief and nothing has been
concealed/suppressed. If at any later stage, any concealment is found on my part, then it will be a case
of mis-representation & concealment of facts. In that event, my appointment on compassionate
grounds would be liable to be terminated.

Deponent
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Annexure- ‘D’

(This NOC in shape of affidavit shall be executed on non-judicial stamp paper of Rs.10/- only & separate affidavit shall be submitted
by each major legal heirs (inclusive of married daughters) who attained the age of 18 yrs. The affidavit should be attested by Notary
public or Ist class Magistrate)

Affidavit/ NOC

I, _____________, wife/son/daughter of late Sh. ------------------, r/o House No.

____________New Delhi, do hereby solemnly affirm and declared as under:

2. That, I am legally wedded wife/son/daughter of late Shri/ Smt.___________, who was working in
DDA as ------on Temp. /Permanent/ W/C (Regular) /Regular Estt in the office of the
____________, New Delhi & expired on-----. The Deceased had left behind the following legal
heirs (Family members):

S.No. Name Age or Relation with marital Educational Employed or un-

date of Qualification employed
deceased Status
birth
1.
2.
3.
4.
5.
6.
7.
8.

3. That there are no legal heirs, except the members shown in para 2 above.

4. That I -------- mother/father/wife/son/daughter of late Shri/Smt --------( for self & on

behalf of minor children shown at S.No._______ above)( if applicable) do hereby relinquish my
right for appointment on compassionate grounds in favour of Sh/Smt./Kumari____________
legal heir of late Sh.___________( deceased employee of DDA).
5. That l will not claim appointment on compassionate grounds at a later date.

6. That I have no objection if appointment on compassionate grounds is given to

Sh/Smt./Km.______________son/wife/daughter of late Sh._______________by the DDA.

7. That none of the family member including myself as mentioned above is in employment of any
Govt./Semi –Govt./ Private Service/business.
OR
That the legal heirs mentioned at S.No.______________ above is/are employed/ working
in__________________________ (Name of organization/ department).

8. That I have not re-married after the death of my husband (in case, the applicant is widow )

Deponent
Verification:
Verified at ____________ on this day _________ of _______, 20__ that the contents mentioned
above are true to the best of my knowledge and belief and nothing has been concealed/suppressed.

Deponent
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