L&T Employees Welfare Foundation MUMBAInews.lnthydrocarbon.com/encnews1/VJS20062017.pdf · L&T...

L&T Employees Welfare Foundation MUMBAI

25th January 2016

CIRCULAR

Enhancement in Eligible Limits / Other Amendments to the Existing Schemes

The Trustees of L&T Employees Welfare Foundation announce the enhancement in eligible limits / other amendments to the existing Schemes.

A – Scheme-wise Amendments: These Amendments have to be read along with schemes & conditions thereof: Scheme 1 Scholarship to meritorious students for doing Graduation & Post-Graduation in Engineering, Architecture & Medicine.

1. Post-Graduation courses included -

a) Engineering & Architecture - scholarship of ₹1,00,000/- &

b) Medicine - scholarship of ₹1,50,000/-.

2 Reimbursement limit for Medical courses (Graduation) enhanced to

₹1,50,000/- from ₹1,25,000/-.

3 Withdrawal of Scholarship for MBA course.

4 Uniform Percentage of Marks to apply for scholarship in respect of Graduation

courses fixed at 70%, revised from 80% for Boys & 75% for Girls.

These amendments will be applicable from the Academic Year 2015 - 16.

Scheme 2 Support Studies of differently abled children of employees.

1. As a part of the existing limit of ₹50,000/-, cost of transportation up to

₹20,000/- per annum per child is included.

This amendment will be applicable from the Academic Year 2015 - 16. Scheme 4 Recognition and Prize for Academic Performance from SSC to Post-Graduation including Professional Courses & Doctorate.

1. Prize amount substantially enhanced for various examinations & percentage of marks.

This amendment will be applicable from the Academic Year 2014 - 15.

…2/-

: 2 :

Scheme 5 Medical Assistance for Life Threatening Diseases (LTDs).

1. Reimbursement limit for Hospitalisation enhanced to `3,00,000/- from

`1,50,000/-.

2. City-wise limit for Hospital room tariff per day specifically mentioned as a part of overall Hospitalisation limit.

These amendments will be applicable for hospitalisation from 1st November, 2015.

Scheme 7 Recognize & Reward Excellence in Major Events, Sports & Games at International / National / Inter- State / Inter - University Levels.

1. Reimbursement of expenses for advanced training from Government

Recognised coaching classes, within a limit of ₹25,000/- per child once in a

block of three years & the first block of three years starts from 1st April, 2015. Maximum reimbursement will be for two blocks covering six years.

This amendment will be applicable from 1st November, 2015.

Scheme 9 Support education of children of employees who died/fully incapacitated while in service & scholarship to meritorious students.

Amendments to the Scheme - Scholarship to Meritorious students: 1. Post-Graduation courses included -

a) Engineering & Architecture - scholarship of ₹1,00,000/- &

b) Medicine - scholarship of ₹1,50,000/-.

2 Reimbursement limit for Medical courses (Graduation) enhanced to

₹1,50,000/- from ₹1,25,000/-.

3 Withdrawal of Scholarship for MBA course.

4 Uniform Percentage of Marks to apply for scholarship in respect of

Graduation courses fixed at 70%, revised from 75% for Boys.

These amendments will be applicable from the Academic year 2015 - 16. Scheme 10 Reimbursement of Maternity Expenses in Complicated Cases.

Reimbursement limit enhanced to `1,00,000/- from `50,000/-.

This amendment will be applicable for maternity expenses incurred from 1st November, 2015.

…3/-

: 3 : B - Others:

I. Annual Income limit has been enhanced to ₹12 Lakhs from ₹10 Lakhs in

respect of the following Schemes:

Scheme 1 - Scholarship to meritorious students for doing Graduation & Post-Graduation in Engineering, Architecture & Medicine.

Scheme 2 - Support studies of differently abled children of employees.

Scheme 6 - Support Medical treatment for differently abled children.

II. In respect of some of the schemes, obtaining of Undertaking from Employee, has been done away with.

The employees who have already submitted claims need not submit revised claims in respect of Schemes 1, 2, 4, 5, 9 & 10. The differential amount due to revision in benefits will be remitted by the LTEWF office subject to availability of balance claimable amount as per documents already submitted earlier with claims. All new claims henceforth can be submitted with the revised limits. All the existing Schemes after incorporating enhancement in eligible limits / other amendments & conditions / forms are enclosed herewith. For any clarification please contact Mr. A.S. Kothurkar on Tel. No.022-67701512 or on e-mail id [email protected]

For L&T Employees Welfare Foundation

Sd/- _________________________

V.J.SHUKLA TRUSTEE Encl : As Above

mailto:[email protected]

L&T Employees Welfare Foundation Scheme – 1

Scholarship to meritorious students for doing Graduation & Post Graduation

in Engineering, Architecture and Medicine (January 2016). Eligibility Income & age criteria: 1. Children of all employees of L&T, its Subsidiary and Associate Companies, who are

serving as permanent employees and have served for a minimum period of 3 years in the company, are eligible to receive scholarship under this scheme. In addition the following conditions are to be fulfilled: a) Gross Annual income is not over ₹12 Lakhs as shown in the TDS certificate of salary

income issued by the company for the immediate preceding financial year i.e. Form 16 (at the time of entry into the scheme). For the employees posted aboard, Overseas Allowance will also be reckoned.

b) Children of retired employees whose Gross Annual Income was as per the limit defined in the above para at the time of retirement and who have served for a minimum of 15 years as permanent employees are also eligible to apply.

2. The term “Children” means legitimate children and legally adopted children up to a

maximum of 2 children. The children should complete Graduation courses by the age of 25 years & Post-Graduation courses by the age of 28 years. Married children of employees are not eligible for the scholarship under the scheme.

3. Norms for award of scholarship for various courses are as under:

I. Students studying for Engineering / Architecture/ Medical courses should have to enroll in colleges/institutes coming under Universities recognized by UGC.

a) Engineering / B.Arch. Courses: The student should have secured minimum of 70% marks /equivalent grade in 12th Standard/equivalent examination to qualify under the Scheme. The students will be ranked according to the marks obtained in the examinations mentioned herein. (Refer point No.3 under Benefits Head)

b) Medical Courses (MBBS & BDS): The students should have secured minimum

of 70% marks in the qualifying examinations to qualify under the scheme. The students will be ranked based on the percentage of marks obtained in Common Entrance Test (CET)/ All India Pre Medical Test (AIPMT). (Refer point No.3 under Benefits Head)

c) Diploma students seeking admission to 2nd year engineering can apply for

the scholarship provided they should have secured minimum of 70% marks in final year Diploma Examination. For 3 year Diploma course, aggregate marks of 5th & 6th Semesters and for 4 year Diploma course, aggregate marks of 7th & 8th Semesters will be considered. Students will be ranked based on percentage of marks obtained in qualifying examination. (Refer point No.3 under Benefits Head).

d) Offer of scholarship for MBA students is withdrawn herewith. …2/-

: 2 : The revision in percentage of marks to 70 will be applicable from academic year 2015-16.

II. Post-Graduation in Engineering / Architecture & Medicine have been added under

the Scheme effective from the academic year 2015-16. The Norms for Scholarship

for Post-Graduation courses in Engineering / Architecture & Medicine:

a) Engineering / Architecture Courses: The students should have secured minimum of 65% marks in the qualifying examinations to qualify under the scheme. The students should get admission in colleges recognized by UGC. The students will be ranked according to the marks obtained in Graduate Aptitude Test in Engineering (GATE)/ Post-Graduate qualifying examination conducted by other Universities (Deemed or Autonomous). (Refer point No.3 under Benefits Head)

b) Medical Courses (Allopathy): The students should get admission in colleges

recognized by UGC.

Existing students studying in any academic year (Second year onwards), can claim scholarship under the Scheme provided s/he meets all eligibility criteria.

III. For students to become eligible for scholarship in subsequent years both in

Graduation & Post-graduation courses, the students should fulfill the following norms:

I. Secure a minimum of 60% marks in the previous year’s examination in

Engineering/ Architecture.

II. Secure a minimum of 50% marks in the previous year’s examination in

Medicine at Graduation level.

Students have to pass the previous year’s examination in the first attempt.

Benefits 1. Reimbursement will be limited to 85% of cost of Tuition fees + Hostel fees + Books

(purchase of Books not exceeding ₹5,000/- per year). The maximum amount of scholarship for Graduation & Post-Graduation per student per academic year:

Engineering & Architecture - ₹1 Lakh Medicine - ₹1.50 Lakhs

2. The benefits will be applicable from Academic Year 2015-16.

3. On an annualized basis, the Trustees will earmark the funds for this scheme and if the

funds allocated for the scheme are fully disbursed and exhausted during that particular year, claims received but unpaid will be taken up for reimbursement in the subsequent year at the sole discretion of the Trustees. The Trustees may use relative ranking as a method to determine the eligible students for disbursement of earmarked fund.

…3/-

: 3 :

Special Conditions 1. Children of employees studying Graduation & Post-Graduation in

Engineering/Architecture will have to sign an undertaking to serve L&T for a minimum period based on scholarship availed, only for Post-Graduation – 1 year, only for Graduation – 2 years & both for Graduation & Post-Graduation – 3 years. In case the child is not joining the company despite selection or after selection does not serve the number of years required as per this paragraph, then the employee has to refund the scholarship amount availed of for the number of years not served.

Selection of the child will be subject to the norms of recruitment/availability of vacancy within the company and suitability for employment under the Company’s GET/PGET schemes.

2. In the case of students who have passed out from L&T Institute of Technology (LTIT)

and availed scholarship under this scheme, the above condition will apply over & above the bond executed by them with LTIT.

3. Employees claiming benefits under this scheme will have to sign an undertaking to

serve the Company for a minimum period of 2 years before disbursement of the amount. In case the employee separates other than by retirement, then the amount paid under the Scheme to the employee/his or her family members for the last two preceding years from the date of separation will be recovered from the employee.

4. The scholarship to meritorious students is available for studies only in India.

5. Any implication of tax on the scholarship amount received will be on the employee’s

account.

How to Apply 1. The claim forms can be collected from Powai Welfare Department (PWD). Duly filled

forms will be processed by PWD.

2. All claim forms should be supported by all the relevant documents as applicable to the scheme. Detailed list of documents to be submitted with the claim is mentioned in the claim form. Incomplete claim may render the application to be rejected.

3. All applicants need to route their applications through their Departmental / HR Head

before forwarding to PWD. 4. The application should be submitted to PWD by end November for the Academic Year

for which application is lodged. The application received after due date will not be considered.

Procedure for Disbursement 1. L&T Management will form a suitable panel for scrutinizing and recommending the

eligible applications for the final approval by the Trustees. The panel’s decision will be final and binding.

2. Employees whose children are selected to receive scholarship will be intimated by PWD

after it has been approved by the Trustees. …4/-

: 4 :

3. The Trustees reserve the right to add, alter, modify, delete or close the scheme without notice at their sole discretion. In all matters concerning this scheme, the Trustees’ decision will be final & binding.

*************

This circular supersedes all the previous circulars on this scheme.


Sd/- ----------------------------- V. J. SHUKLA TRUSTEE

L&T Employees Welfare Foundation – Mumbai Scheme – 1: Scholarship to meritorious students for doing Graduation &

Post-Graduation in Engineering, Architecture and Medicine (Form – January 2016)

Claim Form No: 1 (First Year Graduation & Post-Graduation courses)

I wish to apply for the scholarship for the academic year ______________ (a) Name of Student: _________________ ____________________ _________________

(First name) (Middle Name) (Surname)

(b) Date of Birth: _________________ Age: _______ yrs. (As on 01.06.______)

(c) Sex: ; Married: Yes: / No: (Tick whichever applicable)

(d) Date & Year of 12th Std./Degree Exam:__________

% Marks obtained in 12th Std/Degree Exam:________ % Marks obtained in GATE/CET/AIPMT/PGCET ______________ _ (e) Name of the College: __________________________

(f) Details of claim made for 1st Year: ______________

Details Expenses

incurred (₹)

Amount recommended by

PWD (₹)

Amount sanctioned by

LTEWF (₹)

1. Tuition Fees

2. Hostel Fees

3. Cost of Books

Total (1+2+3)

(Cost of books ₹5,000/- maximum)

Amount claimed - 85% of Total (1+2+3) - ₹ ________________ (To be filled by Applicant)

Amount recommended for sanctioning - ₹________________ (To be filled by PWD)

Amount sanctioned by LTEWF - ₹ ________________ (To be filled by LTEWF)

Any implication of tax on the scholarship amount received by me on behalf of my ward will be on my account.

The particulars furnished above are true to the best of my knowledge.

We agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with this application.

______________________________ _______________________________ Signature of applicant (student) Signature of parent (Employee)

Date: __________________________ Date: ___________________________

Mobile No./Res.No: _______________ Mobile No./Res.No:________________

Email id: ________________________ Email id: _________________________

Name of Employee: _____________________________ PS No: ______________________

In Service Retired VRS (Tick whichever is applicable)

Date of Joining:____________ Date of VRS/Retirement :____________

Cadre & Grade___________ SBU/IC: _________ Dept.Code: ________ Location _____________

Residential Address:_______________________________________________________________

F M

Verification by Dept. / HR Head

The particulars furnished above are verified and are true to the best of my knowledge.

Dept. Head HR Head

Name: ___________________________ Name: ____________________________

PS No: ___________________________ PS No: ____________________________

Designation: ______________________ Designation: ________________________

Signature: ________________________ Signature: _________________________

Mobile No: ________________________ Mobile No: _________________________

Date: ____________________________ Date: _____________________________

Certified/Attested copies of the following documents (except items 4, 5, 6 & 9) to be attached with the Claim form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies).

1. Entrance/12th Examination Mark sheet/Grade sheet/Final year Mark sheet of

Graduation.

2. College Admission Letter.

3. Birth Certificate.

4. Tuition Fee receipts in original.

5. Hostel Fee receipts in original with lodging & boarding break up.

6. Cash Memo/s in original for purchase of Book/s.

7. Company ID card of the employee.

8. Latest Form 16 from Company.

9. Undertaking.

10. Cheque leaf for remitting the amount by way of NEFT.

11. Passport Size Photo.

Verification by Welfare Department

This claim has been verified & undertaking enclosed.

Total eligible amount claimed: ₹_______________________

Amount recommended for sanctioning: ₹____________________________________ (Rupees in words

_________________________________________________________________________________________) Name:_____________________ Signature:_________________________ Date:________________ __________________ _______________ Verification number Date

L&T Employees Welfare Foundation – Mumbai


Claim Form No: 2 (Second Year onwards Graduation & Post-Graduation courses)

(Verification number ____________ Dated ____________ of the previous year’s claim)

I wish to apply for the scholarship for the academic year _______________ (a) Name of Student: ________________ _______________ _______________ (First name) (Middle Name) (Surname) (b) Date of Birth: _____________ Age: _____ yrs. (As on 01.06.______)

(c) Sex : Married: Yes: No: (Tick whichever applicable)

(d) Name of the College: _________________________________ (e) Studying in year: 2nd /3rd /4th (Engg./Arch.)/Final (Arch.): 2nd /3rd /4th /Final(Med): Post-Graduation _____ (Tick whichever applicable) (f) 1st Sem ( %/Grade) _______ 2nd Sem (%/Grade)________ (1st Year Aggregate) ______ 3rd Sem ( %/Grade) _______ 4thSem (%/Grade)________ (2nd Year Aggregate) ______ 5th Sem ( %/Grade) _______6th Sem (%/Grade)________ (3rd Year Aggregate) ______ 7th Sem ( %/Grade) _______8th Sem (%/Grade)________ (4th Year Aggregate) ______ Final Sem/Year (%/Grade)__________________________ (For Arch. / Medical) (g) Details of claim made for __________ Year of (Engg./Arch./Med./Post-Graduation)

Details Expenses incurred

(₹)


PWD (₹)


LTEWF (₹)

1. Tuition Fees

2. Hostel Fees

3. Cost of Books

Total (1+2+3)

(Cost of books ₹5,000/- maximum)

Amount claimed - 85%of Total (1+2+3) - ₹_________________ (To be filled by Applicant)

Amount recommended for sanctioning - ₹_________________ (To be filled by PWD)

Amount sanctioned by LTEWF - ₹_________________ (To be filled by LTEWF)

Any implication of tax on the scholarship amount received by me on behalf of my ward will be on my account. The particulars furnished above are true to the best of my knowledge. We agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application. _______________________________ ________________________________ Signature of applicant (Student) Signature of parent (Employee) Date: __________________________ Date: ___________________________ Mobile No./Res. No.:______________ Mobile No./Res. No: _______________ Email id: ________________________ Email id: _________________________

M F

/

(

Scheme - 1: Scholarship to meritorious students for doing Graduation & Post-Graduation in Engineering, Architecture and Medicine (Form – January 2016)

Name of Employee: _______________ PS No: ___________ In Service Retired VRS (Tick whichever is applicable) Date of Joining: ___________ Date of VRS/Retirement: ______________ Cadre & Grade_________ SBU/IC: _______ Dept. Code: ________ Location: __________ Residential Address: _______________________________________________________



Total eligible amount claimed ₹_____________________

Amount recommended for sanctioning ₹_____________________________ (Rupees in words

___________________________________________________________________________)

Name: ______________ Signature: ________________ Date: ___________ ____________________ _________________ Verification number Date

Certified/Attested copies of the following documents (except items 2, 3, 4 & 6) to be attached with the Claim form. These documents to be attested only by Dept. Head . (Name & Designation of Dept. Head should appear distinctly on attested copies).

1. Mark sheets.





6. Undertaking.

7. Copy of cheque leaf for remitting the amount by way of NEFT.


Verification by Dept. / HR Head The particulars furnished above are verified and are true to the best of my knowledge.

Dept. Head HR Head

Name: _________________________ Name: ___________________________

PS No: _________________________ PS No: ___________________________

Designation: _____________________ Designation: ______________________

Signature: _______________________ Signature: ________________________

Mobile No.: ______________________ Mobile No.: ________________________

Date: ___________________________ Date: ____________________________

L&T Employee Welfare Foundation – Mumbai

Scheme - 1: Scholarship to meritorious students for doing Graduation & Post-Graduation in Engineering, Architecture and Medicine (Form – January 2016)

Claim Form No: 3 (Diploma Holders Direct Admission) - For 2nd

Year Engineering student

I wish to apply for the scholarship for the academic year __________ (a) Name of Student: ________________ _______________ _______________ (First name) (Middle Name) (Surname) (b) Date of Birth:____________ Age: _____ yrs (As on 01.06.______) (c) Sex: ; Married: Yes No (Tick whichever applicable) (d) Date & year 10th/12th Exam:______& %Marks/ Grade obtained in 10th/12thStd:____ (e) Name of Branch (Elec/Mech/Comp etc.):___________ (f) % of Marks: 5thSem ___ %, 6thSem___ % ; Aggregate _____% (For 3 years Diploma ) (g) % of Marks: 7thSem_____%, 8thSem___%; Aggregate ____% (For 4 years Diploma ) (h) Name of the College: ______________________________________ (i) Details of Claim Made for 2nd Year:

Details Expenses

incurred (₹)


PWD (₹)


LTEWF (₹)

1. Tuition Fees

2. Hostel Fees

3. Cost of Books

Total (1+2+3)

(Cost of books ₹5,000/- max.)

Amount claimed - 85%of Total (1+2+3) - ₹__________________ (To be filled by Applicant)

Amount recommended for sanctioning - ₹__________________ (To be filled by PWD)

Amount sanctioned by LTEWF - ₹__________________ (To be filled by LTEWF)

Any implication of tax on the scholarship amount received by me on behalf of my ward will be on my account. The particulars furnished above are true to the best of my knowledge. We agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application. ________________________________ ________________________________ Signature of applicant (student) Signature of parent (Employee) Date: ___________________________ Date: ___________________________ Mob No./Res.No.:_________________ Mob No./Res.No.:_________________ Email id: ________________________ Email id: _________________________

Name of Employee: _____________________________ PS No: ____________________


Date of Joining:____________ Date of VRS/Retirement :____________

Cadre & Grade__________ SBU/IC:_________ Dept.Code:________ Location ___________

Residential Address:___________________________________________________________

F M



Total eligible amount claimed ₹_____________________

Amount recommended for sanctioning ₹_____________________________ (Rupees in words

___________________________________________________________________________)

Name: ______________ Signature: ________________ Date: ___________ ____________________ _________________ Verification number Date

Certified/Attested copies of the following documents (except items 5, 6, 7 & 10) to be attached with the form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies).

1. Mark sheets/Grade sheet of 5,6,7 & 8 semesters of Diploma as applicable.

2. Mark Sheet for 10thStd & 12thStd (if appeared).

3. College Admission Letter.







10. Undertaking.




Dept. Head HR Head

Name: _________________________ Name: ___________________________

PS No: _________________________ PS No: ___________________________

Designation: _____________________ Designation: ______________________

Signature: _______________________ Signature: ________________________

Mobile No.: ______________________ Mobile No.: ________________________

Date: ___________________________ Date: ____________________________

Name :___________________________ PS No:_____________________

Designation :______________________ SBU/IC :___________________

Email id :__________________________ Contact No: ___________________

Signature :_______________ Location ______________ Date :___________

LTEWF/Scheme-01(Edu)

Date: _________________

Scheme – 1

Scholarship to meritorious students for doing Graduation & Post Graduation in Engineering, Architecture and Medicine

Undertaking

Thru. : Dept. Head : __________________________

I, Ms./Mr.___________________________________________, PS no.________________,

Dept./SBU/IC_________________________, hereby declare that pursuant to receiving

benefits under the Scheme “Scholarship to meritorious students for doing Graduation &

Post-Graduation in Engineering, Architecture and Medicine”, I will serve Larsen &Toubro and

/or it’s Subsidiary and Associate Companies for a minimum period of 2 years.

Over and above this my ward will also serve the company for a minimum period of 1/2/3

year/s# after graduation/Post-graduation in Engineering / Architecture (* in addition to his

existing bond with L&T Institute of Technology), subject to meeting the norms of recruitment

/ availability of vacancy with company, and suitable for employment under the GET/PGET

schemes.

# Pl. refer point 1 of Special Conditions of the Scheme and strike out which is not relevant.

* strike out in case not applicable.

In-case I fail to work for the specified period of 2 years from the date of disbursement/s

received by me under this scheme or my ward fails to join L&T after qualifying, I hereby

authorize

a) Larsen & Toubro or It’s Subsidiary/Associate Companies to recover the sum

of monies received under the said scheme by me/ my family members in the

preceding two years from date of separation under the said scheme from my

settlement amount. In case my ward is not joining after being selected & I

continue to be in employment then the amount can be recovered from me.

b) The amount so deducted / recovered be remitted to L&T Employees Welfare

Foundation in settlement of the amount paid to me / my family members

under this Scheme.

__________________________________ ________________________________

Employee’s Signature / Date Ward’s Signature / Date

Contact number ______________________ Contact number __________________

_________________________________________________________


____________________________________________

HR Head, Signature & Name

(Form – 01/2016)


Support studies of differently abled children of employees (January 2016).

Eligibility 1. Children of all employees of L&T, it’s Subsidiary and Associate Companies who are

serving as permanent employees and have served for a minimum period of 3 years in the company, are eligible to receive support for studies under this scheme. In addition the following conditions are to be fulfilled:

a) Gross Annual income is not over ₹12 Lakhs as shown in the TDS certificate of salary


b) Children of retired employees whose Gross Annual Income was as per the limit defined in the above para at the time of retirement and who have served for a minimum of 15 years as permanent employees are also eligible to apply.

2. The term “Children” means legitimate children and legally adopted children up to a

maximum of 2 children. Married Children with disability will not be covered under this scheme.

3. The term “differently abled children” would include children having disabilities mentioned in Annexure ‘A’.

4. Certification from government recognized institute, which confirms a minimum of 15% of such disability, needs to be obtained.

Benefits 1. The amount of reimbursement will be 90% of the cost of vocational training subject to a

maximum limit of ₹50,000/- per annum per child. This amount will include reimbursement of up to a maximum of – (a) cost of Books & Uniform of ₹5,000/- & (b) cost of transportation to school & back ₹20,000/-.

2. On an annualized basis, the Trustees will earmark the funds for this scheme and if the funds allocated for the scheme are fully disbursed and exhausted during that particular year, claims received but unpaid will be taken up for reimbursement in the subsequent year at the sole discretion of the Trustees.

Special Conditions 1. Concerned employee need to obtain prior approval from the management panel for

admission to any vocational course & reimbursement of transportation expenses. 2. Any implication of tax on the reimbursement amount received by the employee on

behalf of her/his ward will be to the account of the employee.

...2/

: 2 :



2. All claim forms should be supported by all relevant documents as applicable to the scheme. Detailed list of documents to be submitted with the claim is mentioned in the claim form. Incomplete claim may render the application to be rejected.

3. All applicants need to route their applications through their Departmental / HR Head before forwarding to PWD.

4. Application should be submitted to PWD once the child has been enrolled for any

vocational training.

5. Last date for receiving application will be end November for the academic year for which application is lodged.



2. Employees whose children are selected to receive reimbursement will be intimated by

PWD after it has been approved by the Trustees. 3. The Trustees reserve the right to add, alter, modify, delete or close the scheme without

notice at their sole discretion. In all matters concerning this scheme, the Trustees’ decision will be final & binding.

*************




Annexure – ‘A’

(Form – 01/2016)

Disability Categories

1 Autism 8 Orthopedic impairment

2 Blindness 9 Other health impairment

3 Deafness 10 Specific learning disability

4 Emotional disturbance 11 Speech or language impairment

5 Hearing impairment 12 Traumatic brain injury

6 Intellectual disability 13 Visual impairment (including blindness)

7 Multiple disabilities



ENROLLMENT FORM No : 1A

I wish to apply for enrollment of my ward for the academic year ___________________

Details of differently abled Child

a. Name of the Student: _____________________ _________________ _______________

(First Name) (Middle Name) (Last Name)

b. Date of Birth: _____________ Age: ______ years

c. Sex: Married : Yes No (Tick whichever is applicable)

d. Type of Problem : _________________________________________________________

_______________________________________________________________________

e. Name of the course :______________________________

f. Name of Employee: _____________________________ PS No ______________


Date of Joining: ____________ Date of VRS/Retirement______________

Cadre & Grade :___________ SBU/IC:________ Dept. Code____________ Location: ____________

Email id :__________________________________ Contact No:_____________________________

Name of Spouse: ___________________________________________________________

I agree to abide by the decision of the Management Panel & the Trustees in all matters concerned

with my application.

I confirm that the above statements are true and have been verified by me.

Signature of employee _______________________ Date _______________________________

Residential Address: ____________________________________________________________

Tel No.: ____________________________ Mobile No.:_________________________________

Email id:________________________________________________________________________

Scheme- 2: Support studies of differently abled children of employees (Form – January 2016)

M F

Certified/Attested copies of the following documents to be attached with the enrollment form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies)

1. Admission letter of concerned Vocational training institute.

2. Certification from Government recognized institute confirming minimum of 15%

disability.

3. Mark Sheet.


5. Birth Certificate of Child.



The above facts have been checked by me from the employee’s record with the company.

Name :__________________________Signature____________ Date_______________

_______________________________ ____________

Verification / Enrollment number Date


Dept. Head HR Head

Name : ________________________ Name : ___________________________

PS No: ________________________ PS No: ___________________________

Designation : ___________________ Designation : ______________________

Signature : _____________________ Signature : ________________________

Mobile No. : ____________________ Mobile No. : _______________________

Date : _________________________ Date : ____________________________

Name :___________________________ PS No:_____________________




Claim Form No: 1B

(Enrollment No_______________________________)

(Verification No._______________________ Dated__________of previous claim)

Name of employee:__________________________________________ PS No_________


Date of Joining:___________ Date of VRS/ Retirement___________

Cadre & Grade ___________ SBU/IC: _______ Dept. Code:________ Location:________

Address :_________________________________________________________________

Mobile No.:___________________ Office Tel No :__________________

Email id : ________________________________________

I submit my application for reimbursement of vocational / educational / transportation expenses

for the academic year: _______________________________________________________

Name of Student (in block letters )________________________________________

Sex: Married : Yes No (Tick whichever is applicable)

Disability: ___________________________________________________________

Name of Institution/ Organization: ________________________________________

Name of the Course:___________________________________________________

Duration : _______________________

Details of claim made:

Tuition Fees : ₹________________ Transportation Expenses ₹ ______________

Others (Books & Uniform max. ₹5,000/- for both put together) : ₹______________

Total : ₹ _________________

Eligible amount claimed as per scheme* ₹_______

(*90 % of the Total or ₹50,000/- whichever is lower)

Any implication of tax on the reimbursement amount received by me will be on my account. The particulars furnished above are true to the best of my knowledge.

I agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application.

Name of Employee:_______________________________________________________

Signature :________________________ Date:______________

Scheme - 2 : Support studies of differently abled children of employees (Form – January 2016)

(Revised Form - June,14).

M F

Certified/Attested copies of the following documents (except item no. 1, 5 & 6) to be attached with the form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies).

1. Tuition Fee receipts.

2. Certification from Government recognized institute confirming minimum of

15% disability.

3. Mark sheets.

4. Course completion certificate/Mark sheet at the end of the course.

5. Bills for Transportation expenses along with receipt for payment.

6. Cash memo for uniform & books.




Verification by Welfare Department This form has been verified.

Amount claimed ₹____________________

Amount recommended for sanctioning ₹________________________ (Rupees in words

_____________________________________________________________________) Name: ___________________________ Signature: ____________Date: ____________ _______________________ _______________ Verification number Date


Dept. Head HR Head

Name : ________________________ Name : ________________________

PS No: ________________________ PS No: ________________________

Designation : ___________________ Designation : ___________________

Signature : _____________________ Signature : _____________________

Mobile No. : ____________________ Mobile No. : ____________________

Date : _________________________ Date : _________________________

Name :___________________________ PS No:_____________________




L&T Employees Welfare Foundation

Scheme – 3 Recognize & Reward winners of National / State level Scholarship Examinations &

Olympiad (Mathematics & Sciences) (January 2016).

(e.g. National Talent Search Examination, etc.) Eligibility 1. Children of all employees of L&T, its Subsidiary and Associate Companies who are

serving as permanent employees and have served for a minimum period of 2 years in the company are eligible to apply under this scheme. Children of retired employees who have served for a minimum of 15 years as permanent employees are also eligible to apply.

2. The term “Children” means legitimate children and legally adopted children. Married children of employees are not eligible for the reward under the scheme.

Benefits 1. The reward amount is as per Annexure – ‘A’ attached.


funds allocated for the scheme are fully disbursed and exhausted during that particular year, claims received but unpaid will be taken up for reimbursement in the subsequent year at the sole discretion of the Trustees.

Special Conditions 1. The child should have secured the scholarship certificate either at International /

National / Regional or State level as per Annexure – ‘A’.

2. Any implication of tax on the reward amount received by the employee will be on the employee’s account.


forms will be processed by PWD. 2. All claim forms should be supported by all relevant documents as applicable to the

scheme. Detailed list of documents to be submitted with claim is mentioned in the claim form. Incomplete claim may render the application to be rejected.

3. All applicants need to route their applications through their Departmental / HR Head

before forwarding to PWD. 4. Application should be submitted to PWD within two months of receiving the scholarship

certificate. Application received later will not be considered.

…2/-

: 2 : Procedure for Disbursement 1. L&T Management will form a suitable panel for scrutinizing and recommending the


2. Employees whose children are selected to receive award will be intimated by PWD after

it has been approved by the Trustees.



Name of Examination Eligibility One-Time Reward

National Talent Search

Examination 10

th

/ 11th

Std. ₹25,000/-

State Talent Search

Examination 10

th

Std. ₹15,000/-

State Scholarship Examination 7

th

Std./Equivalent ₹7,000/-

State Scholarship Examination 4

th

Std./Equivalent ₹4,000/-

Olympiad (Mathematics &

Sciences) conducted by

National Board for Higher

Mathematics (NBHM).

8th/10th & 11th Std. / Equivalent.

Regional Level -₹15,000/- National Level -₹25,000/- International Level -₹50,000/-

(Form – 01/2016)

*************


For L&T Employees Welfare Foundation Sd/- ----------------------------- V. J. SHUKLA TRUSTEE

L&T Employees Welfare Foundation – Mumbai.

Scheme – 3 : Recognize & Reward winners of National / State level Scholarship Examinations &

Olympiad (Mathematics & Sciences). (Form – January 2016)

Claim Form

I wish to apply for reward for my ward for the academic year _______________

a. Name of the Student: _____________________ _________________ _____________ (First Name) (Middle Name) (Surname)

b. Date of Birth: ___________ Age: _________ years.

c. Sex: ; Married : Yes No (Tick whichever is applicable)

d. Standard:____________________

e. Details of Scholarship Examination: ___________________________________________________

f. Name of Scholarship Examination passed: ______________________________________________ g. Name of School:__________________________________________________________________

h. Date & Year of Examination: ____________

i. Percentage of marks or Grade or Rank (whichever applicable): ______________________________

j. Eligible amount claimed as per scheme: ₹____________________

Any implication of tax on the prize money received by me on behalf of my ward will be on my account. The particulars furnished above are true to the best of my knowledge. I agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application.

Name of Employee: _______________________________________ PS No _______________________ In service Retired VRS (Tick whichever is applicable)

Date of Joining: _________________ Date of VRS/Retirement : ____________

Cadre & Grade: __________ SBU/IC: ___________ Dept. code: _________ Location:______________ Mobile No: ________________________________ Email id :________________________________ Signature :_________________________________ Date:_________________________________ Residential Address: ___________________________________________________________________

M F


This form has been verified.

Amount claimed ₹_____________________

Amount recommended for sanctioning ₹__________________________________ (Rupees in words

__________________________________________________________________________________)

Name: ______________________________________ Signature: ____________Date: ____________ _____________________ _______________ Verification number Date

Certified/Attested copies of the following documents to be attached with the claim form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies).

1. Scholarship Certificate (In case certificate is not received at the time of applying, letter from school authority on the school letter head in the prescribed format as per Annexure- 1 should be submitted).

2. Mark Sheet.




Dept. Head HR Head

Name : ________________________ Name : ___________________________

PS No: ________________________ PS No: ___________________________




Date : _________________________ Date : ____________________________

Name :___________________________ PS No:_____________________




Annexure - 1

School Letterhead

Date : ___________________

TO WHOMSOEVER IT MAY CONCERN

This is to certify that Miss/Master _______________________________

was awarded the Scholarship for standard _______________ Examination

conducted by _________________________ in the year ______________.

S/he has secured ___________________ percentage/rank.

_________

Name of Principal & Signature

School stamp (Form – 01/2016)


Recognition and Prize for Academic Performance from SSC to Post-Graduation including

Professional Courses & Doctorate (January 2016).

Eligibility

Children of all permanent employees of L&T, its Subsidiary and Associate Companies. Children of retired employees who have served for a minimum of 15 years as permanent employees are also eligible to apply. The children of employees who have retired after 1st January are eligible to apply for the subsequent academic year. The children of deceased employees are also eligible to apply. The Final year’s aggregate percentage of marks/ CGPA and marks allotted on Grade basis which will be converted to equivalent percentage as applicable would be considered for deciding the eligibility. Students who have appeared for examinations conducted by Schools / Colleges and Other Institutions based in India & having recognition from State or Central Government / UGC are only eligible to apply for Prize money for Academic Performance. Students have to pass the examinations in the first attempt. Students, awarded Doctorate by Universities recognized by UGC or other recognized Indian Institutes on or after 1st April 2015, are eligible to apply. The term “Children” means legitimate children & legally adopted children. The prize for academic performance will be given to a maximum of two children who are not above the age of 25 years at the completion of the courses. The age limit will be 28 years at the completion of the courses in respect of Post-Graduation in Engineering, Architecture & Medicine. There is no age limit for children doing Doctorate. Married children of the employees are not eligible for claiming prize amount under the scheme except in respect of Doctorate.

Benefits Prize for Academic Performance 1. The Prize amount is as per Annexure – ‘A’ attached. This will be effective from academic

year 2014-15.


Special Conditions 1. Any implication of tax on the prize money received by the employee’s children will be

either on the employee or on the applicant as the case may be.

How to Apply 1. The claim forms can be collected from your IC HR/Powai Welfare Department (PWD).

Duly filled forms will be processed by PWD.

2. All claim forms should be supported by all the relevant documents as applicable to the scheme. Detailed list of documents to be submitted with the claim is mentioned in the claim form. Incomplete claim may render the application to be rejected.

…2/-

: 2 :


4. The application should be submitted to PWD by end November for the Academic Year for which application is lodged. The application received after due date will not be considered.



2. Employees’ whose children are selected to receive prize amount will be intimated by PWD after it has been approved by the Trustees.



Prize for Academic Performance:

1. SSC or Equivalent Examination.

SSC or Equivalent examination with marks indicated.

Passing in 1st attempt with percentage of marks as under:

Prize Amount (₹)

70 % & above but less than 80% 3,500



95 % & above 15,000

SSC or Equivalent examination without marks but Grade Point Average indicated.

Passing in 1st attempt with GPA (10 point scale):

Prize Amount (₹)

7 & above but < 8 3,500

8 & above but < 9 5,000

9 & above but < 9.5 10,000

9.5 & Above 15,000

2. HSC or Equivalent Examination.

HSC or Equivalent examination with marks indicated.


Prize Amount (₹)




95 % & above 20,000

HSC or Equivalent examination without marks but Grade Point Average indicated.

Passing in 1st attempt with GPA (10 point scale):

Prize Amount (₹)

7 & above but < 8 5,500

8 & above but < 9 7,500

9 & above but < 9.5 15,000

9.5 & above 20,000

3. Final year examination of any degree /Post-Graduate degree / Doctorate.

Final year examination of any degree / post-Graduate degree / Doctorate.


Prize Amount (₹)



80 % & above but less than 85 % 12,500


90 % & above 25,000

90% & above for Post-Graduation 50,000

Doctorate 1,00,000

4. Final year examination of any diploma*

Final year examination of any Diploma.


Prize Amount (₹)





90 % & above 20,000

*Only Govt. approved Diploma courses as decided by the management would be considered for prize amount.

5. CA, CMA, CS Examinations:

Passing in first attempt: Prize Amount (₹)

Student who has passed all groups / parts. 25,000

Student who is in the First Fifty in All India Merit List. 50,000

*************




Claim Form for Recognition & Prize for Academic Performance

I wish to apply for prize for the academic year ____________________

a) Name of Student: ________________ _______________ _______________ (First name) (Middle Name) (Surname) b) Date of Birth: _____________ Age: ______________yrs. c) Sex: ; Married : Yes No (Tick whichever is applicable)

d) School/College/Name of university: __________________________________ e) Date of Exam/ Year of passing: ________________________________________ f) Percentage of Marks or Grade or Rank whichever applicable : ______________ (Aggregate Percentage / CGPA / Rank ) g) Name of Examination : X/XII/Grad./PG/Dip./CA,CMA,CS/Doctorate (Tick whichever applicable) h) Eligible amount claimed as per scheme: ₹______________________

Any implication of tax on the prize money received by the child will be either on the employee’s or the applicant’s account as the case may be. The particulars furnished above are true to the best of my knowledge. We agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application. _______________________________ __________________________________ Signature of applicant (student) Signature of parent (Employee) Date: __________________________ Date: _____________________________ Mobile No/Res. No:_______________ Mobile No. /Res. No.:_________________ Email id: ________________________ Email id: ___________________________

Name of Employee: ____________________________________ PS. No:______________ In service Retired VRS (Tick whichever is applicable) Date of Joining: _____________________ Date of VRS/ Retirement: ___________________ Cadre & Grade: __________SBU/IC: ___________Dept. Code ________Location: _______________ Residential Address: ________________________________________________________________

Scheme – 4: Recognition and Prize for Academic Performance from SSC to Post- Graduation including Professional Courses & Doctorate.

(Form – January 2016)

M F



Dept. Head HR Head

Name : ________________________ Name : ___________________________

PS No: ________________________ PS No: ___________________________




Date : _________________________ Date: ____________________________


This claim has been verified. Amount claimed ₹_____________________

Amount recommended for sanctioning ₹__________________________________ (Rupees in words

________________________________________________________________________________) Name :___________________________ Signature: ____________ Date ________________ ______________________ ______________ Verification number Date

Certified/Attested copies of the following documents to be attached with the form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies).


2. Mark sheet.


4. Cheque leaf / copy of the applicant’s passbook with IFSC Code of the bank for

remitting the amount by way of NEFT (Please note remittance will be only made

to the Bank account of applicant).

5. In case of Doctorate copy of Thesis.

L&T Employees Welfare Foundation Scheme 5

Medical Assistance for Life Threatening Diseases (LTDs) (January 2016).

Eligibility 1. Scheme covers spouses and employees, present and retired, of L&T, its Subsidiary and

Associate Companies who are/were serving as permanent employees and have served for a minimum period of 5 years in the company before retirement, their two living children up to age of 21 years and spouses including two living children up to age of 21 years of deceased employees.

2. Medical Assistance will be provided for Life Threatening Diseases which are given in Annexure ‘A’.

3. Employee whose spouse is working and covered by medical scheme provided by his/her employer shall not be eligible for this benefit.

Benefits 1. Reimbursement will be for the cost of treatment in respect of hospitalization only

subject to a limit of ₹3,00,000/- per annum after exhausting all other sources of reimbursements including their personal insurance cover wherever applicable. Unutilized amount, if any, in a particular Financial Year will not be carried forward to the next Financial Year. The limit of ₹3,00,000/- per annum for hospitalization will cover expenses incurred on or after 1st November, 2015.

2. Limit for Reimbursement of Room Tariff is as under: Tier I Cities - ₹3,500/- Tier II Cities - ₹3,000/- Tier III Cities - ₹2,500/- Room Tariff can be claimed only from one of the sources. Room tariff will be part of hospitalization limit mentioned above. Refer Annexure ‘B’ for list of cities covered.


Special Condition 1. Any implication of tax on the reimbursement amount received under the scheme will be

on the employee’s account.


forms will be processed by Powai Medical Services (PMS).


…2/-

: 2 :

3. All applicants need to route their applications through their Departmental / HR Head before forwarding to PMS.

4. Application should be submitted to PMS within one month after treatment.



2. Employees to receive reimbursement will be intimated by PMS after the Trustees have approved it.

3. The Trustees reserve the right to add, alter, modify, delete or close the scheme without


Annexure ‘A’

List of LTDs Covered under Scheme

1. Heart 6. Spine

2. Cancer 7. Bone & Joints

3. Brain 8. Major Surgeries involving abdominal and thorax region Spine

4. Kidney 9. Accidents leading to major surgeries of brain, spine, joint replacement

5. Liver

Annexure ‘B’

Tier-wise list of the Cities

Tier Cities

I Delhi, Mumbai, Kolkata, Chennai

II Pune, Bangalore, Hyderabad, Surat, Baroda, Kochi, Ahmedabad

III Ahmednagar, Jamshedpur, Mysore, Vizag, Coimbatore, etc.

(Form – 01/2016)

*************


For L&T Employees Welfare Foundation Sd/- ----------------------------- V. J. SHUKLA

TRUSTEE

L&T Employees Welfare Foundation – Mumbai Scheme - 5 : Medical Assistance for Life Threatening Diseases (LTDs) (Form – January 2016)

Claim Form

Name of employee: _____________________________________________ PS NO._______________

Sex: In service Retired VRS (Tick whichever is applicable)

Date of Joining:__________________________ Date of VRS/Retirement _______________________

Cadre & Grade ____________SBU/IC:_____________Dept. Code :__________ Location:__________

Office Address :_____________________________________________________________________ _________________________________Off Tel No./Mobile No.: ______________________________ Residence Address_________________________________________________________________ _________________________________Res.Tel No./Mobile No.:______________________________ Email id : _________________________________________________________________________

Name of Patient _________________________________ Relation with Employee________________ Details of Disease / Ailment: ____________________________________________________________ I submit my application for reimbursement under Medical assistance for Life Threatening Diseases (LTDs) for the financial year _____________ for the treatment of self / my relation ________________________________ (spouse / child – up to age of 21 years).

Details Expenses incurred

(₹)

Amount recommended

by PMS (₹)


LTEWF (₹)

A - Total expenses incurred

B – Excess amount of Room Tariff over and

above my entitlement included in A.

C ( A – B)

D - Less amount received from : #

1

2

Subtotal – D

Total E ( C – D)

Maximum Eligible Amount – ₹3,00,000/-

# Please indicate against item numbers 1 & 2 under D the amount received from other sources if any, to meet the hospitalization expenses. You may attach a separate sheet under D if need be. Proof of such receipts should be attached along with the claim form. Any implication of tax on the amount received by me will be on my account. The particulars furnished above are true to the best of my knowledge. I agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application.

Name of Employee: ________________________________________ Place: ___________________ Signature: ________________________________________________ Date : ___________________

M F


Dept. Head HR Head

Name : ________________________ Name : ___________________________

PS No. ________________________ PS No. ___________________________



Mobile No. : ____________________ Mobile No. : ________________________

Date : _________________________ Date : _____________________________

Verification by Powai Medical Services

This claim has been verified & found in order.

Amount claimed ₹__________________, Room Rent as per the bill ₹ _______________________

Room Rent entitled as per rules ₹ _________ Room Rent received from any sources ₹________

Amount recommended for sanctioning ₹______________________________ (Rupees in words

_______________________________________________________________________________)

Name :_________________________ Signature :___________________Date: ________________

__________________ _________________ Verification number Date


1. Discharge Card.

2. Hospitalization bills / Cash Memos for purchase of medicines.

3. Receipts for payments made to hospital.

4. Investigation reports.

5. Prescription for purchase of medicines.

6. Declaration Form.



LTEWF/Scheme-5(Med)

Date: __________________

Medical Assistant for Life Threatening Disease (LTDs)

Declaration

Submission of claim for reimbursement of Hospitalization expenses

under the above scheme

I, Ms./Mr.________________________________ PS No._____________________,

Dept./SBU/IC____________________________, hereby confirm the following:

1. S/he is employed with ________________________________________ and not getting any medical reimbursement from the employer.

2. My son / daughter is below 21 years and not employed.

3. My son / daughter is above 21 years and is employed with ______________________________________ and not getting any medical reimbursement from the employer.

4. I have not claimed any amount under Mediclaim Policy for this hospitalization.

The particulars furnished above are true to the best of knowledge.

______________________________

Employee’s Signature

____________________________________

Dept. Head, Signature & Name

(Form – 01/2016)


Support medical treatment for differently abled children (January 2016).

Eligibility

1. Children of all employees of L&T, its Subsidiary and Associate Companies who are serving as permanent employees and have served for a minimum period of 5 years in the company are eligible to receive support for medical treatment under this scheme. In addition the following conditions are to be fulfilled:

A. Gross Annual income is not over ₹12 Lakhs as shown in the TDS certificate of salary


B. Children of retired employees whose Gross Annual Income was as per the limit defined in the above para at the time of retirement and who have served for a minimum of 15 years as permanent employees are also eligible to apply.

2. The term “Children” means legitimate children. The scheme covers maximum of two

children. Married Children with disability will not be covered under this scheme.

3. The term “differently abled children” would include children having disabilities mentioned in Annexure ‘A’.

4. Certification from government recognized institute, which confirms a minimum of 15% of such disability, needs to be obtained.

Benefits

1. Reimbursement of expenses related to medical treatment - Refer Annexure ‘B’ (Table 1).

2. Limits for reimbursement – Refer Annexure ‘B’ (Table 2).


Special Conditions

1. Any implication of tax on the reimbursement amount received by the employee will be to the account of the employee.

2. Concerned employee needs to obtain prior approval from the management panel before

undertaking treatment.

… 2/-

: 2 :

How to Apply

1. The claim forms can be collected from Powai Welfare Department (PWD). Duly filled forms will be processed by PWD.


3. All applicants need to route their application through their Departmental / HR Head

before forwarding to PWD.

4. Application should be submitted to PWD within one month after treatment.

Procedure for Disbursement

1. L&T Management will form a suitable panel for scrutinizing and recommending the eligible applications for the final approval by the Trustees. The panel’s decision will be final and binding.

2. Employees to receive reimbursement will be intimated by PWD after it has been approved by the Trustees.


Annexure ‘A’

(Form – 01/2016)

Disability Categories

1 Autism 8 Orthopedic impairment

2 Blindness 9 Other health impairment

3 Deafness 10 Specific learning disability

4 Emotional disturbance 11 Speech or language impairment

5 Hearing impairment 12 Traumatic brain injury

6 Intellectual disability 13 Visual impairment (including blindness)

7 Multiple disabilities

Annexure ‘B'

Table 1: Therapy Covered

Speech Therapy Occupational Therapy Physiotherapy

Remedial Therapy Play Therapy Music & Dance Therapy

Group Therapy Individual Therapy Cognitive Therapy

Hydro Therapy Sensory Integration Therapy Speech & Language Intervention

All Day Learning Special Education Brain Function / Neuro Feedback(w.e.f. 01/04/2015)

Table 2: Reimbursement Details (Limits)

Category Reimbursement limit

Therapies covered as given in above table 90% of the claim, which should not exceed

more than ₹2 Lakhs per annum.

Hearing Aid 90% of the cost - once in two years which

should not exceed more than ₹2 Lakhs

Other appliances like wheel chair, calipers, crutches etc.

90% of the cost - once in two years which should not exceed more than ₹2 Lakhs

Surgical cost ₹1 Lakh once in two years

Medical Consultation, Physical and Mental Assessment tests. (Hospitalization / OPD basis) (w.e.f. 01/04/2015).

50% of expenses or ₹25,000/- per annum whichever is lower

Transport expenses. (Prior approval of Panel required)

₹5,000/- per month.

(Form – 01/2016)

*************


For L&T Employees Welfare Foundation Sd/- ----------------------------- V. J. SHUKLA

TRUSTEE


Scheme 6 – Support medical treatment for differently abled children (Form – January 2016)

ENROLLMENT FORM No: 1A

Sr.

No

No. of Family Members & their Names Relation with the

Employee

Occupation

Significant medical history of employee: ________________________________________ ________________________________________________________________________ Significant medical history of family members: ___________________________________ ________________________________________________________________________ Details of the Sickness of the Child for whom claim is lodged. ________________________

Details of the Employee:

Name of Employee: _____________________________ PS.No. ________________________

Sex: M F (Tick whichever is applicable)


Date of Joining: _____________________ Date of VRS/ Retirement ______________________

Cadre & Grade:____________SBU/IC:____________Dept.Code:___________Location: ___________

Date of birth of Employee: __________________ Age of employee: _______________________

Education: ______________________________________________________________________

Office Address: __________________________________________________________________

______________________________Off.Tel. No. /Mobile No.: _______________________________

Email id: __________________________________________________________________________

Residential Address: _______________________________________________________________

_______________________________Res.No./Mobile No.:_________________________________

Spouse Name: _________________________________ Mobile No.__________________

Email id: ___________________________________________________________________________

Name of the child

DOB / Age

Gender Edu. Health Problems – (Tick where applicable)

Sensory Loss Physical Neurological Mental

Describe the disability & treatment taken up till now: ______________________________________ ________________________________________________________________________________ I agree to abide by the decision of the Management Panel & the Trustees in all matters concerned

with my application. I confirm that the above statements are true and have been verified by me.

Employee’s Signature: _______________________ Date: ______________________

Certified/Attested copies of the following documents to be attached with the enrollment form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies). 1. Certification from Government recognized institute confirming minimum of 15% disability.

2. Medical certificate pertaining to the current treatment / therapies undertaken.


4. Birth Certificate of Child.

5. Photo of the child (post card size).


Dept. Head HR Head

Name : ________________________ Name : ___________________________

PS No. :_______________________ PS No.: ___________________________




Date : _________________________ Date : ____________________________

Verification by Welfare Dept.

The above facts have been checked by me from the employee’s record with the company.

Name: _______________________________________Signature____________ Date_______________

____________________________ ____________

Verification / Enrollment number Date


Claim Form No: 1B

(Enrollment number of Form No. 1A ____________________)

(Verification number: _______________________ Date ________of previous claim)

Name of employee:___________________________________ PS NO : ____________ Sex: (Tick whichever is applicable)


Date of Joining:____________________ Date of VRS/Retirement ___________________

Cadre & Grade__________ SBU/IC:____________Dept.Code :______Location:_______ Office Address :____________________________________________________________ ______________________________Off. Tel No./Mobile No._________________________ Email id :________________________________________________________________ Residence Address:_______________________________________________________ _______________________________Res.Tel.No._______________________________ Email id : _______________________________________________________________ Any implication of tax on the reimbursement amount received by me will be on my account.

I submit my application for reimbursement under Support medical treatment for differently abled children scheme for the period (From ______________ To__________________) Name of child / Disability of the child: ________________________________________

Particulars of Treatment

Details of the Bill

Expenses

Incurred (₹)

Amount Approved by

PWD (₹)

Amount Sanctioned by

LTEWF (₹)

Total (₹)

The particulars furnished above are true to the best of my knowledge. I agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application. Name of Employee: ________________________________________ Place: _________ Signature: ________________________________________________ Date: __________

Scheme – 6 : Support medical treatment for differently abled children.

(Form –January 2016)

M F

;


Dept. Head HR Head

Name : ________________________ Name : ___________________________

PS No. ________________________ PS No. ___________________________




Date : _________________________ Date : ____________________________


This claim has been verified.

Amount claimed: ₹_______________________

Amount recommended for sanctioning : ₹_________________________ (Rupees in words

_________________________________________________________________________________)

Name :____________________Signature :__________________Date: ________________

___________________ ________________

Verification number Date


1. Hospitalization bills / Cash Memos for purchase of instruments / appliances.

2. Bill for transportation expenses.

3. Consultant’s bill.

4. Receipts for all payments with number of sessions attended. If the amount of claim is

above ₹5,000/- the receipt should have revenue stamp.




Recognize & Reward Excellence in Major Events, Sports & Games at International/

National / Inter-State/ Inter-University Levels (January 2016).

Eligibility 1. Children of all employees of L&T, its Subsidiary and Associate Companies who are

serving as permanent employees. Children of retired employees who have served for a minimum of 15 years as permanent employees are also eligible to apply.

2. The term “Children” means legitimate children and legally adopted children. 3. Winners, first & second runners up & even those who qualify to participate in all

major Events, Sports & Games at International, National, Inter-State and Inter-University (Universities recognized by UGC) levels are eligible for award under the scheme. Events, Sports & Games will be as per the pattern followed by Asian and Olympic games.

Benefits 1. Rewards per annum per Events/Sports/Games as per details given below:

i) International level up to ₹2 Lakhs. ii) National level up to ₹1 Lakh. iii) Inter-State level up to ₹50,000/-.

iv) Inter-University level up to ₹25,000/-.

2. Each child will be entitled to claim for maximum of any two Events/Sports/Games per financial year.

3. Claim restricted to same Events/Sports/Games in a financial year only at one of the

levels. 4. Reimbursement of expenses for advanced training from Recognized Government

Coaching Classes within a limit of ₹0.25 Lakh per child once in a block of 3 years & Maximum reimbursement will be for two blocks covering six years. The first block of 3 years starts from 1st April, 2015.


Special Conditions 1. Children who receive award under this scheme are expected to impart training and

guidance to other children. 2. Any implication of tax on the reward amount received by the children will be on the

employee’s account. …2/-

: 2 : How to Apply 1. The claim forms can be collected from Powai Welfare Department (PWD). Duly filled



3. All applicants need to route their applications through their Departmental / HR Heads before forwarding to PWD.

4. Application should be submitted to PWD within one month of qualifying under the scheme. Application received after due date will not be considered.

5. The application pertaining to the current financial year will only be considered. Procedure for Disbursement 1. L&T Management will form a suitable panel for scrutinizing and recommending the


2. Employees whose children are selected to receive award money will be intimated by



*************





Claim Form

I wish to apply for my ward for reward for excellence in Events/Sports/Games for the

financial year _____________

a.) Name of the child: ________________ ______________ ____________

(First name) (Middle Name) (Surname) b.) Date of Birth: __________ Age: _____ yrs (As on 01.06.______) c.) Sex: ; Married: Yes: No: (Tick whichever is applicable) d.) School/College: _________________________________ e.) Coaching Class Name: ____________________ Recognition from: __________ f.) Write-up on Coaching imparted: g.) Name of Events/Sports/Games: _______________________________________ h.) Participation Details: i.) Date & Year of the Event: _________________ j.) Eligible amount claimed as per scheme: ₹____________________________

Any implication of tax on the award amount received by my child will be on my account. The particulars furnished above are true to the best of my knowledge. I agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application. Name of Employee: _____________________________ PS No.: ___________________


Date of Joining: ___________________ Date of VRS/Retirement: _______________ Cadre & Grade: _______ SBU/IC: _________Dept. Code: _________Location: __________ Residential Address: ________________________________________________________ _________________________________________________________________________ Mobile Number: __________________ Signature of Employee: ___________________________ Date: __________________

Scheme - 7: Recognize & Reward Excellence in Major Events, Sports & Games

at International / National / Inter-State / Inter-University Levels (Form – January 2016)

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Certified/Attested copies of the following documents to be attached with the form. These documents to be attested by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies)

Certified/Attested copies of the following documents (except items 4) to be attached with the Claim form: These documents to be attested only by Dept. Head. (Name & Designation of Dept. head should appear distinctly on attested copies).

1. Award Certificate or any other Proof of Award.




5. Cheque leaf of participant for remitting the amount by way of NEFT.

(Please note remittance will be only made to the Bank account of participant).



Dept. Head HR Head

Name: ________________________ Name: ___________________________

PS No. ________________________ PS No. ___________________________

Designation: ___________________ Designation: ______________________

Signature: _____________________ Signature: ________________________


Date: _________________________ Date: ____________________________

Verification by SUB Head/ IC HR The particulars furnished above are true to the best of my knowledge.

Name: _____________________ PS No: ____________________



Amount claimed ₹________________

Amount recommended for sanctioning ₹____________________________ (Rupees in words

________________________________________________________________________) Name: __________________________ Signature: ____________ Date: _____________ _______________________ ___________________ Verification number Date


Support towards training & education to help in rehabilitating spouse of deceased

employees or of fully incapacitated employees to become employable (January 2016).

Eligibility 1. “Spouse” of deceased employee or fully incapacitated employee of L&T, it’s Subsidiary

and Associate companies who were serving as permanent employees at the time of demise or incapacitation and have served for a minimum period of 5 years in the company.

2. The benefit of this scheme can be availed only by the legally wedded spouse of deceased or fully incapacitated employees.

3. If the spouse remarries then benefits under this scheme will not be given.

4. No age bar for enrollment of the spouse under this scheme.

5. For benefits under this scheme, the spouse should register for any recognized course with Private/Government Vocational/Educational/Professional Organization (Refer Annexure ‘A’).

Benefits 1. 75% of the Course Fee with a limit of ₹1 Lakh per financial year will be reimbursed for

the duration for course not exceeding three years.

2. The spouse of deceased or fully incapacitated employee can claim for reimbursement of maximum two short or one long term course (Refer Annexure ‘A’) in a particular financial year, once during their lifetime.


Special Conditions 1 Spouse of deceased/fully incapacitated employee, needs to obtain prior approval from

the management panel before enrolling for any of the eligible courses as defined in Annexure ‘A’.

2 The course chosen should help the spouse in becoming employable or enable the spouse to be self-employed.

3 If the spouse wishes to join any other course other than mentioned in Annexure ‘A’ the decision to sanction will rest with the management panel.

4 Any implication of tax on the reimbursement amount received under the scheme will be to the account of the employee’s spouse.

…2/-

: 2 :




3. All applicants need route their application through their Departmental / HR Head before forwarding to PWD.



2. Spouses selected to receive reimbursement will be intimated by PWD after it has been

approved by the Trustees. 3. The Trustees reserve the right to add, alter, modify, delete or close the scheme without


Annexure ‘A’

Details of Courses

Tailoring & Embroidery Computer Course

Fashion Designing Typing, DTP

Textile Designing Secretarial Course

Art & Craft Montessori Teacher’s training Course

Beauty Parlor Para Medical Courses

Jewelry Designing Graduation, Degree / Diploma

Driving Food processing /Bakery & Confectionery

Catering Housekeeping

(Form – 01/2016)

*************



L&T Employees Welfare Foundation - Mumbai

ENROLLMENT FORM No :1A

I wish to apply for enrollment for the financial year ___________________

Details of Spouse of deceased/ incapacitated employee

a. Name of the spouse (in block letters):

_______________________ ________________________ ______________________ (First Name) (Middle Name) (Surname) b. Date of Birth: _____________ Age: ____________ years

c. Sex: (Tick whichever is applicable)

Residential Address: __________________________________________________________

___________________________________________________________________________

Tel No.: ____________________________ Mobile No.:_______________________________

Email id:____________________________________________________________________

Name of deceased/ incapacitated employee:_____________________________________

Date of Joining: _____________________ PS.No:______________

Cadre & Grade: ________SBU/IC:____________Dept Code:________ Location:__________

Date of Expiry/ Incapacitation:______________

Name of the Institute with Address : ______________________________________

Name of the Course : __________________________________________________

I agree to abide by the decision of the Management Panel & the Trustees in all

matters concerned with my application.

I confirm that the above statements are true.

Signature of Spouse_____________________ Date _____________________

M F

Scheme 8: Support towards training & education to help in rehabilitating spouses of

deceased employees or of fully incapacitated employees to become employable.


Verification by Welfare Department This form has been checked by me from the employee’s record with the Company and found correct. Name: ___________________________________Signature_______________Date____________ ___________________________ _____________ Verification / Enrollment number Date

Certified/Attested copies of the following documents to be attached with the enrollment form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies).

1. Copy of Death Certificate /Certificate of incapacitation of the Employee. 2. Original letter from the Institute enrolled for the Course.


Dept. Head HR Head

Name : ________________________ Name : ___________________________

PS No. ________________________ PS No. ___________________________


Signature : _____________________ Signature : _____________________ __


Date : _________________________ Date : ____________________________

L&T Employees Welfare Foundation, Mumbai

Claim Form No :1B

(Enrollment No :____________________________________________________)

(Verification number: _____________________ Date_________of previous claim)

Details of Spouse of deceased/ incapacitated employee

a. Name of the spouse (in block letters):

_______________________ ________________________ ____________________ (First Name) (Middle Name) (Surname) b. Date of Birth: _____________ Age: __________years c. Sex: ( Tick whichever is applicable)

Residential Address:

_______________________________________________________________________

_______________________________________________________________________

Tel No.: ____________________________ Mobile No.:___________________________

Email id :________________________________________________________________ Name of deceased/ incapacitated employee:____________________________________ Date of Joining: _____________________ P S. No.:____________________________ Cadre & Grade: _________ SBU/IC: __________ Dept. Code: ________Location: ______ Date of Expiry/ Incapacitation:______________

I request you to reimburse the vocational/ educational expenses for the Financial

Year: _____________________

Name of College / Institution: ____________________________________________

Name of the Course: __________________________________________________

Duration: _________________ ₹ Per Annum/ course tenure: _______________

Expenses incurred Amount Claimed (₹) Eligible amount - ₹1 Lakh or 75% of

expenses incurred whichever is lower

Tuition Fees (attach receipts/ vouchers)

Scheme - 8 : Support towards training & education to help in rehabilitating spouses of

deceased employees or of fully incapacitated employees to become employable


M F

Copy of cheque leaf for remitting the amount by way of NEFT or Cheque in favour of (Name of Institution): __________________________________

I confirm the above. Original Fee Receipt / Vouchers for the amount claimed is

enclosed & I shall submit the mark sheet/ course completion certificate at the end of

the course.

Any implication of tax on the reimbursement amount received will be on my account.

I agree to abide by the decision of the Management Panel & the Trustees in all

matters concerned with my application.

Name: _________________________________ Place: _____________________

Signature: ___________________ Date: _____________________



Dept. Head HR Head Name: _____________________________ Name : ______________________________ PS No. : ____________________________ PS No. :______________________________ Designation : ________________________ Designation : __________________________ Signature: ___________________________ Signature: ____________________________ Mobile No.: __________________________ Mobile No.: ___________________________ Date : ______________________________ Date : _______________________________

Certified/Attested copies of the following documents (except item 3) to be attached with the claim form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies).

1. Death Certificate /Certificate of incapacitation of the Employee.


3. Tuition Fees (attach receipts/ vouchers) .

Verification by Welfare Department This claim has been verified.

Total eligible amount claimed: ₹__________________

Amount recommended for sanctioning ₹____________________________ (Rupees in words

___________________________________________________________________________) Name: ___________________________________Signature_______________Date_________ __________________ ________ Verification number Date

Annexure ‘A’

Details of courses

Tailoring & Embroidery Computer Course

Fashion Designing Typing, DTP

Textile Designing Secretarial Course

Art & Craft Montessori Teacher’s training Course

Beauty Parlor Para Medical Courses

Jewelry Designing Graduation, Degree / Diploma

Driving Food processing /Bakery & Confectionery

Catering Housekeeping

(Form – 01/2016)


Support education of children of employees who died/fully incapacitated while in service

& scholarship to meritorious students (January 2016).

Eligibility 1. Children of deceased or fully incapacitated employees of L&T, it’s Subsidiary and

Associate Companies who were serving as permanent employees at the time of demise or incapacitation and have served for a minimum period of 3 years in the company.

2. The term “Children” means legitimate children and legally adopted children up to a maximum of 2 children.

3. The child should have completed the age of 3 years and should not be above the age of 25 years as on the first day of the academic year in respect of which the claim is being made.

4. Children from the marriage of a deceased employee whose spouse remarries can claim benefits provided proper documents are submitted like death certificate etc. The payment will be made to the child or the spouse of the deceased employee.

5. Students who are studying in Pre-Primary, Primary, Secondary, Junior & Senior Colleges,

and Professional courses can apply under the scheme provided they have passed previous year’s examination.

6. Scholarship to Meritorious students is given in point I , II & III below :

I. Meritorious students doing Graduation in Engineering / Architecture / Medical

courses can avail of Scholarship provided they enroll in colleges/institutes coming under Universities recognized by UGC and fulfill the following conditions. (This is applicable w.e.f. academic year 2015 -16).

A. Engineering / B.Arch. Courses: The student should have secured minimum

of 70% marks /equivalent grade in 12th Standard/equivalent examination to qualify under the Scheme. The students will be ranked according to the marks obtained in the examinations mentioned herein.

B. Medical Courses (MBBS & BDS): The students should have secured minimum

of 70% marks in the qualifying examinations to qualify under the scheme. The students will be ranked based on the percentage of marks obtained in Common Entrance Test (CET)/ All India Pre Medical Test (AIPMT).

C. The students, who secure admission for 2nd year engineering course on

successful completion of Diploma, can apply for the scholarship provided they should have secured minimum of 70% marks in final year Diploma Examination. For 3 year Diploma course, aggregate marks of 5th & 6th

Semesters and for 4 year Diploma course, aggregate marks of 7th & 8th Semesters will be considered. Students will be ranked based on percentage of marks obtained in qualifying examination.

D. Offer of scholarship for MBA students is withdrawn forthwith. …2/-

: 2 :

II. Meritorious students doing Post-Graduation in Engineering / Architecture & Medicine can avail of Scholarship provided they fulfill the following conditions. (This is applicable w.e.f. academic year 2015 -16). a) Engineering / Architecture Courses: The students should have secured

minimum of 65% marks in the qualifying examinations to qualify under the scheme. The students will be ranked according to the marks obtained in Graduate Aptitude Test in Engineering (GATE)/ Post-Graduate qualifying examination conducted by other Universities (Deemed or Autonomous).

b) Medical Courses (Allopathy): The students should get admission in colleges recognized by UGC.

Existing students studying in any academic year (second year onwards), can claim scholarship under the scheme provided s/he meets all eligibility criteria. However, for Post-Graduation courses the child should pass the examination before completion of age of 28 years.

III. For students to become eligible for scholarship in subsequent years both in Graduation & Post-Graduation courses, the students should fulfill the following norms: A - Secure a minimum of 60% marks in the previous year’s examination in

Engineering / Architecture.

B - Secure a minimum of 50% marks in the previous year’s examination in Medicine at Graduation level.

Students have to pass the previous year’s examination in the first attempt.

Students who have appeared for examinations conducted by Schools / Colleges and Other Institutions based in India & having recognition from local, state or central government / UGC are only eligible to apply under the Scheme.

Benefits 1. Tuition Fees & other expenses will be reimbursed at actuals subject to ceiling as given in

Annexure ‘A ’, per child per academic year.

2. In respect of Meritorious students Scholarship amount per academic year will be : The maximum amount for Graduation & Post-Graduation per student:

Engineering & Architecture - ₹1 Lakh Medicine - ₹1.50 Lakhs

For details of reimbursement of expenses, please see Annexure ‘B’.

3. Student who is not qualifying to apply for Meritorious scholarship in subsequent year/s as given in Annexure ‘B’ above can avail of the benefits as given in Annexure ‘A’. A student eligible to claim Meritorious scholarship as defined in point 6 above (As per annexure ‘B’), will not be entitled to get benefit under point 1 (As per Annexure ‘A’).

…3/-

: 3 :


funds allocated for the scheme are fully disbursed and exhausted during that particular year, claims received but unpaid will be taken up for reimbursement in the subsequent year at the sole discretion of the Trustees.

Special conditions 1. Where both father and mother are employees, in case of death or incapacitation of

either of them, the children will not be eligible to avail the benefits of this scheme. 2. Any implication of tax on the reimbursement amount received under the scheme will be

on the beneficiary’s account. How to Apply 1. The claim forms can be collected from Powai Welfare Department (PWD). Duly filled




4. The application should be submitted to PWD by end November for the Academic Year for which application is lodged. The application received after due date will not be considered.

5. A child who fails and is not promoted to a higher standard will not be eligible for reimbursement in that particular year. This condition may be waived on the recommendation of the Panel in the case of a child who has failed and who is not promoted to the next higher standard on account of ill health.



2. Employees whose children are selected to receive reimbursement will be intimated by


notice at their discretion. In all matters concerning this scheme, the Trustees’ decision will be final & binding.

Annexure ‘A’

(Amount in ₹)

Items of

Expenditure

Pre-primary,

Primary &

Secondary

Junior &

Senior College

Professional

Courses

Tuition Fee 15,000 30,000 60,000

Uniform 2,000 2,000 -

Books 4,000 3,500 5,000

Transport 4,000 2,500 3,000

Hostel 9,000 12,000 12,000

Total Eligible Amount

34,000 50,000 80,000

Annexure ‘B’ Scholarship for Meritorious students limit:

1. Graduation & Post-Graduation in Engineering / Architecture - ₹1,00,000/- 2. Graduation & Post-Graduation in Medicine - ₹1,50,000/- 3. The above scholarship amount will include

a) Tuition Fees b) Hostel Fees c) Books (not exceeding ₹5,000/-)

4. Maximum eligible amount will be 85% of item no.3 above subject to limits shown in point 1 & 2.

(Form – 01/2016)

*************



L&T Employees Welfare Foundation - Mumbai

Scheme 9 : Support education of children of employees died/ fully incapacitated while in service & Reward of scholarship to meritorious

students. (Form – January 2016)

ENROLLMENT FORM No : 1 A

Name of deceased / incapacitated employee _____________________________________ PS No. : ________________ Date of Joining:________________ Cadre :______________ Date of Expiry/Incapacitation: ____________________ SBU/IC: ___________________ Dept. Code:____________________ Location: ________________________________ Name of Spouse /Guardian: ______________________________ Relation: ____________ Address :_________________________________________________________________ _________________________________________________________________________ Mobile /Res.No. :______________________ Email id: _____________________________

Data regarding the children to be enrolled:

Sr. No.

Name Date of Birth (enclose proof)

Sex Standard Remarks, if any

1

2

I agree to abide by the decision of the Management Panel & the Trustees in all matters

concerned with my application.

I confirm that the above statements are true and have been verified by me.

Signature: ___________________ Date: __________________


Dept. Head HR Head

Name : ______________________ Name : ____________________________

PS No: ______________________ PS No: ____________________________

Designation : _________________ Designation : _______________________

Signature : ___________________ Signature : _________________________

Mobile No. : __________________ Mobile No. : ________________________

Date : ________________________ Date : _____________________________


The above facts have been checked by me from the employee’s record with the company. Name: _____________________________________ PS No :___________________ SBU / IC :___________________________ Location : _________________________ Signature:___________________________ Date: ____________________________ Verification/Enrollment No.______________________ Date:_____________________


Scheme - 9 : Support education of children of employees died / fully incapacitated while in service & Reward of scholarship to meritorious

students. (Form – January 2016)

Claim Form No: 1 B

(Enrollment number______________________ & Date ______________)

Name of deceased / incapacitated employee _____________________________________ PS No. : ________________ Date of Joining:________________ Cadre :______________ Date of Expiry/Incapacitation: ___________________ SBU/IC: _______________________ Dept. Code: _______________________ Location: ________________________________ Name of Spouse / Guardian: ____________________________ Relation: ______________ Address :__________________________________________________________________ _________________________________________________________________________ Mobile/Res.Tel. No.:____________________ Email id:_____________________________

I request you to reimburse the educational expenses of my children for the Academic

Year: ____________________

Name (in block letters )

First Child

Second Child

Name of School/Institution

Standard

Standard

Amt. per academic year (₹) Amt. per academic year (₹) Expenses incurred

Amount claimed

Eligible amount as per scheme

Amount claimed

Eligible amount as per scheme

1. Tuition Fee

2. Uniform

3. Books

4. Transport

5. Hostel

Total Amount

I confirm that the above statements are true. Any implication of tax on the reimbursement amount received under the scheme will be on my account.

I agree to abide by the decision of the Management Panel & the Trustees in all matters

concerned with my application.

Name of the Spouse/ Guardian: ______________________________________________

Signature: _____________________________________ Place: _____________________


Dept. Head HR Head

Name : ______________________ Name : ___________________________

PS No: ______________________ PS No: ___________________________

Designation : _________________ Designation : ______________________

Signature : ___________________ Signature : ________________________

Mobile No. : __________________ Mobile No. : ________________________

Date : ________________________ Date : _____________________________


This claim has been verified. Amount claimed : ₹______________________________

Amount recommended for sanctioning ₹________________________ (Rupees in words

______________________________________________________________________) Name : ________________ Signature: ____________________ Date ______________ _______________________ ______________________ Verification number Date

Certified/Attested copies of the following documents (except items 5, 6, 7, 8 & 9) to be attached with the Claim form: These documents to be attested only by Dept. Head. (Name & Designation of Dept. head should appear distinctly on attested copies.)

1. Death Certificate /Certificate of incapacitation of the Employee.

2. Entrance/Mark sheet of earlier year’s examination/ Grade sheet/ Graduate Final year

Mark sheet.

3. School/College Admission Letter.


5. Tuition Fee receipts.

6. Cash Memo for uniforms purchased.

7. Cash Memo/s for purchase of books.

8. Receipt for payment for transport.


10. Annual Progress Report.


Annexure ‘A’

(Amount in ₹)

Items of

Expenditure

Pre-primary,

Primary & Secondary

Junior & Senior

College

Professional

Courses

Tuition Fee 15,000 30,000 60,000

Uniform 2,000 2,000 -

Books 4,000 3,500 5,000

Transport 4,000 2,500 3,000

Hostel 9,000 12,000 12,000

Total Eligible Amount

34,000 50,000 80,000

Annexure ‘B’ Scholarship for Meritorious students limit:

1. Graduation & Post-Graduation in Engineering / Architecture - ₹1,00,000/- 2. Graduation & Post-Graduation in Medicine - ₹1,50,000/- 3. The above scholarship amount will include

a) Tuition Fees b) Hostel Fees c) Books (not exceeding ₹5,000/-)

4. Maximum eligible amount will be 85% of item no.3 above subject to limits shown in point 1 & 2.

(Form – 01/2016)


Reimbursement of Maternity Expenses in Complicated Cases (January 2016).

Eligibility 1. Scheme covers employees & spouses of employees, of L&T, its Subsidiary and Associate

Companies who are serving as permanent employees and have served for a minimum period of 3 years in the company.

2. Employee whose spouse is working and covered by medical scheme provided by employer shall not be eligible for this benefit.

3. Scheme will apply for two maternities to meet expenses only in complicated cases

however normal delivery excluded. Benefits 1. Reimbursement will be ₹1,00,000/- or actual expenses incurred whichever is lower.

The amount payable under this scheme will be after exhausting all limits including their personal insurance cover wherever applicable.

2. This limit of ₹1,00,000/- will be applicable for maternity expenses incurred on or after 1st November, 2015.

3. The nature of complicated cases will be decided by Director-Medical, Health & Welfare Services of Larsen & Toubro Limited.


Special Condition 1. Any implication of tax on the reimbursement amount received under the scheme will be

on the employee’s account.

How to Apply 1. The claim forms can be collected from Powai Welfare Department. Duly filled forms will

be processed by Powai Medical Services (PMS).


3. All applicants need to route their application through their Departmental / HR Head before forwarding to PMS.

4. Application should be submitted to PMS within one month after discharge from hospital.

…2/-

: 2 :

Procedure for Disbursement 1. L&T Management will form a suitable panel which will include Director-Medical, Health

& Welfare Services for scrutinizing and recommending the eligible applications for the final approval by the Trustees. The panel’s decision will be final and binding.

2. Employees who have to receive reimbursement will be intimated by PMS after the

approval of Trustees.


*************




Scheme – 10 : Reimbursement of Maternity Expenses in Complicated Cases.

Claim Form (Form – January 2016)

Name of employee:_____________________________________________ PS NO. ___________

Sex (Tick whichever applicable)

Date of Joining:__________________________

Cadre & Grade ____________SBU/IC:_____________Dept. Code :__________ Location:_______

Office Address :__________________________________________________________________ _________________________________Off Tel No/Mobile No. :__________________________ Residence Address_______________________________________________________________ _________________________________ Res. Tel No/Mobile No . :_______________________ Email id : _______________________________________________________________________

Name of Patient _________________________________ Relation with Employee – Self / Spouse Details of the Case: _________________________________________________________________

I submit my application for your consideration under the scheme “Reimbursement of Maternity Expenses in Complicated Cases”.

Details

Expenses

Incurred (`)

Amount Approved by

PMS (`)

Amount Sanctioned by

LTEWF (`)

A - Total expenses incurred

B - Less amount received from : #

1

2

Subtotal – B

Total C ( A – B)

Maximum Eligible Amount – ₹1,00,000/-

# : Please indicate against item numbers 1 & 2 under B the amount received from other sources if any, to meet the hospitalization expenses. You may attach a separate sheet under B if need be. Proof of such receipts should be attached along with the claim form.

Any implication of tax on the reimbursement amount received under the scheme will be on my account. The particulars furnished above are true to the best of my knowledge. I agree to abide by the decision of the Management Panel & the Trustees in all matters concerned with my application. Name of Employee: ________________________________________ Place: __________________ Signature: ________________________________________________ Date: ___________________

M F



Dept. Head HR Head

Name :____________________________ Name: ___________________________

PS No : ___________________________ PS No.: ___________________________

Designation: Designation :_______________________

Signature: ________________________ Signature: _________________________

Mobile No.:________________________ Mobile No. :________________________

Date: ____________________________ Date: _____________________________


1. Discharge Card.

2. Hospitalization bills / Cash Memos for purchase of medicines.

3. Receipts for payments made to hospital.

4. Investigation reports.

5. Prescription for purchase of medicines.

6. Declaration Form.



Verification by Powai Medical Services

Certified that the above claim is covered under the Scheme & has been verified & found in order.

Amount claimed `________________

Amount recommended for sanctioning `______________________________ (Rupees in words

____________________________________________________________________________)

Name :_________________________Signature :___________________Date: _____________

__________________ _________________ Verification number Date Name:__________________________________ Designation: Director – Medical, Health & Welfare Services Larsen & Toubro Limited

Signature: _____________________ Date: ____________________

LTEWF/Scheme-10(Med)

Date: _______________

Reimbursement of Maternity Expenses in Complicated Cases

Declaration

Submission of claim for reimbursement of Hospitalization expenses

under the above scheme

I, Ms./Mr.___________________________________________ PS No.________________,

Dept./SBU/IC___________________________________, hereby confirm the following:

1. My wife is a house wife.

2. S/he is employed with ______________________________________ and not getting any medical reimbursement from the employer.

3. I have received ₹____________________ from the Company under the Company’s

Scheme.

4. I have not claimed any amount under Mediclaim Policy for this hospitalization.

The particulars furnished above are true to the best of knowledge.

________________________________

Employee’s Signature

________________________________

Dept. Head, Signature & Name

(Form – 01/2016)


Providing Financial Assistance in case of Natural Calamities (January 2016).

Eligibility 1. Present and retired employees of L&T, its Subsidiary and Associate Companies who

are/were serving as permanent employees of the company.

2. Spouse & two children are also covered under the scheme.

3. The natural calamities happening from 1st April, 2015 will be covered under the scheme.

Benefits 1. Benefit of ₹3 Lakhs is payable only in the case of death & out of such natural calamities

& benefit will be payable for each case of death. The amount will be paid only to the surviving member out of the four family members mentioned above. No relatives of the family of the employee will be entitled to receive any money under the scheme in the event of death of all.


Nature of Natural Calamities: a) Earthquake b) Flood c) Tsunami d) Lightning & Thunder e) Thunderstorm f) Hurricane g) Tornado h) Rainstorm These are only explanatory in nature & any other calamity happening & not covered above will be decided from time to time. The Natural calamities happening have to be declared by a competent authority.




3. The applicant needs to route her/his application through the employee’s Departmental/ HR Head before forwarding to PWD.

4. Application should be submitted to PWD within three months from the date of natural calamity.

…2/-

: 2 : Procedure for Disbursement 1. L&T Management will form a suitable panel for scrutinizing and recommending the


2. Employee/Survivor/Guardian who has to receive the amount will be intimated by PWD after the Trustees have approved it.

3. The Trustees reserve the right to add, alter, modify, delete or close the scheme without


*************





Scheme – 11 : Providing Financial Assistance in case of Natural Calamities

Claim Form (Form – January 2016)

Name of employee:_____________________________________________ PS NO ___________

Sex (Tick whichever is applicable)

In service Retired VRS (Tick whichever is applicable)

Date of Joining:__________________________ Date of VRS/Retirement ___________________

Cadre & Grade ____________SBU/IC:___________Dept. Code :__________ Location:________

Office Address :_________________________________________________________________ _________________________________Off Tel No/Mobile No.:___________________________ Residence Address_______________________________________________________________ _________________________________Res. Tel No/Mobile No.:_________________________ Email id : ______________________________________________________________________

Name of Applicant: ___________________________ Relation with Employee______________ Details of Natural Calamity : ______________________________________________________ List of Persons Died : Name___________________ Age ________ Relation With employee_____________________ Name___________________ Age ________ Relation With employee_____________________ Name___________________ Age ________ Relation With employee_____________________ I submit my application for payment under the scheme.

Name of Applicant: ________________________________________ Place: ________________ Signature: _______________________________________ Date : ________________

M F



Dept. Head HR Head

Name :___________________________ Name: _________________________

PS No.: __________________________ PS No.: ________________________

Designation: Designation: _____________________

Signature: ________________________ Signature: ______________________

Mobile No.:________________________ Mobile No.:______________________

Date: ____________________________ Date: ___________________________



Amount claimed `__________________________

Amount recommended for sanctioning `_________________________________ (Rupees in words

_____________________________________________________________________________________) Amount to be paid in favour of _____________________________________________________ Name: _____________________ Signature: ____________ Date: ________________ ___________________ _____________________ Verification number Date

Certified/Attested copies of the following documents to be attached with the form. These documents to be attested only by Dept. Head. (Name & Designation of Dept. Head should appear distinctly on attested copies).

1. Attested copy of Declaration of natural calamity from competent authority.

2. Death Certificate/s & Original letter from competent authority stating that death

has occurred as a result of natural calamity giving name of the persons died on

whose behalf claim is made.

3. List of Surviving member/s with birth certificates duly attested.

4. Affidavit duly notarized in case claim is made on behalf of the Minor.

5. Cheque leaf of the surviving member.


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