Form-W5 Housing Subsidy - Rubber Board Labour Welfare Division Application Form For Housing Subsidy For Plantation Workers (Other Than Ne Sector)
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1
2
3RUBBER BOARD Labour Welfare Division
For Office use: Date:
Form
Application Form for Housing Subsidy for
W5
Application No.:
Plantation Workers (Other than NE Sector)
Tick the applicable boxes.
TO BE FiLLED By THE APPLicANT
Membership No.
(Only if applied for any benefit from Rubber Board earlier)
Name of Applicant (in Capital letters)
(Name as in the Bank Pass Book)
Name of Father Mother Husband
–
–
Male
Female Date of Birth
Age
Category
SC
ST
OBC
General
House No./
Name
Post Office
PIN Code
Village
Taluk
District
State
STD Code
Land Phone No.
Mobile Phone No.
Aadhar No.
Bank
Branch
IFS Code
Account No.
Details of benefits (if any) received from Rubber Board with the name of Regional Office:
d
d
- m m - y y
y
y
Employment Details
Total Years of
Date of joining
Tick the appropriate category below
employment
as worker
Tapper
GPC Worker
Factory Worker
General Worker
Non-Supervisory Worker
No. of plantations in which the applicant is doing tapping job
Total trees tapped per day by the applicant
Have you attended Tappers Training? Yes No SDITT TTS Certificate No.
Are you a member Yes
No
Name of RPS if member of
of Tappers Bank?
Tappers Bank or a GPC worker
To be filled in by
Name of Employer
the Employer
Name & Address of
Estate/GPC/Factory
Estate Permit No.
STD Code
Land Phone No.
Mobile Phone No.
Large Estate
Land Area (Ha)
Average working days per
Total number of trees tapped
Small Estate
month in the estate/GPC
by the applicant in the estate
Total monthly wages
Specify the relationship of the
including all allowances
applicant with the employer (if any)
Location/nearest bus stop of the holding/estate/GPC:
The details given in this application are completely correct to the best of my knowledge and belief.
Date:
Signature of Applicant:
** Signature of Employer/RPS President/Rubber Board Officer
** Furnish the details of RPS or
Rubber Board Officer certifying
the details
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