Ministry of Statistics & Programme Implementation

 

 

Name of the Scheme:                        Provision of Shelter Houses for looking after the Animals.

 

 

APPLICATION FORM FOR NEW PROPOSAL

 

1.         Organisation Name                            :

 

Address                                              :

 

Tel. No.                                               :

 

Fax No.                                               :

 

Telex Nod E‑Mail No/Grams            :

 

(i)         Name of the Act under                      :

which registered

 

(ii)        Registration No. and date                 :

of Registration

(Please attach a photocopy)

 

2.         Any other Organizationlinsft./           :

Body if applicable, Give details

 

3.         Registration under Foreign               :

Contribution Act

 

4.         Memorandum of Association                        :

and Bye‑Laws

(Please attach a photocopy)

 

5.         Name and Address of the                  :

Members of the Board of

Management/Governing Body

 

6.                  Availability of Land : The following information may be furnished

(i)         Land Area:

(ii)        Location of Land for Shelter House:

(iii)       Whether the land is registered in the name of the Org:

(iv)       If the land is registered in the name of the Org:­

(a)        Whether it is available on long‑term lease

(b)        Whether revenue records are available if the land is donated by Panchayat or any other person/body

(c)        Any other status of land such as Registered/Special Power of Attorney etc.

(v)        A Blue Print/Site Plan duly approved by the local authority/approved valuer.

(vi)       The Certificate that the Organization is in possession of land without any Encumbrances.

 

7.         A copy of the Annual cum Progress Report and Audited Annual Accounts for the previous year (s) which should contain the Balance Sheet, Income & Expenditure A/c and Peceipt & Payment A/c.

 

8 (a)     Budget Estimates for construction of Shelter House to be furnished as per following items:

 

S. No.              List of Items                                                   Maximum amount admissible

                                                                                                            (Rs. in Lakhs)

 

1.                     Cost of boundary wall with man proof fencing                      3.00

2.                     Cost of construction of in house dispensary             3.00

3.                     Cost of Medical equipment                                                   1.25

4.                     Cost of construction of shelters                                            13.00

5.                     Cost of construction of water tank(s)                                    1.75

6.                     Cost of construction of drains                                               1.75

7.                     Contingencies                                                             1.25

‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑

Total:                          25.00

                                                                                                            ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑

 

*          The item‑wise amount indicated above is the maximum entitlement for the construction of Shelter House but the actual entitlement will be calculated as per requirement of the Organization on the basis of particulars furnished.

 

(b) The Budget Estimates are required to be prepared by CPWD/State PWD/Approved Valuer along with the certificate that the rates are not more than the prevailing P.W.D. schedule of rates for similar work.

 

(c) The Organization is required to contribute minimum 10% of the total cost of the project.

 

9.         Details of Beneficiaries/facilities available with the Organization as per Annexure I

10.       Details of Staff Employed as per Annexure II

11.       List of documents to be attached as per Annexure‑III

12.       List of additional papers, if any given:

 

I/We have read the Scheme and fulfill the requirements and conditions of the Scheme. I/We undertake to abide by all the conditions of the Scheme.

 

Signature                    :

 

Name                          :

 

Address/Seal              :

 

Dated                          :

 

Note:   Wherever not applicable, specialty in case of new Organization, please write‑ N.A.

 

 

 

 

ANNEXURE I

 

MINISTRY OF SOCIAL JUSTICE & EMPOWERMENT

 

Name of the Scheme:

 

Details of Beneficiaries/Facilities available with the Organization

 

(i)         Name of the Organization:

(ii)        Name and address of the Project:

(iii)       Year/Previous Year:

 

Detail of Beneficiaries

 

Type of Animal           No. of Animals                       Male               Female

 

 

Details of Facilities available

 

1.         Whether the Organization has in‑house dispensary?                                  Yes/No

2.         Whether the Services of the Veterinary Surgeon available?                      Yes/No

If yes, full time/part time/weekly etc.

3.         Whether First‑aid facility to animals available?                                          Yes/No

4.         Whether the Organization have any Bio‑gas plant?                                    Yes/No

5.         Whether facility for adequate water supply exists?                         Yes/No

If yes, indicate the source thereof

6.         Whether necessary drainage system exists?                                               Yes/No

7.         Whether the Organization has got necessary resources to                         Yes/No

maintain the animal shelter,

If yes, give details

ANNEXURE ‑ II

 

MINISTRY OF SOCIAL JUSTICE & EMPOWERMENT

 

Name of the Scheme :

 

Details of the Staff Employed

 

Part I (Previous Year)

 

(I)        Name of the Organization:

 

(II)       Name and address of the Project:

 

(III)     Year

 

S. No.     Name and              Educational           Date of               Period for which      Salary    Total salary      Remarks                                     Qualification        Appointment      employed during      per          paid during           

                                                                                                             The year                   month     the year

 

 

 

 

 

 

 

Part II (Current Year):

 

(I)        Only notify change from the previous year:

 

(II)             In case there is no change in the part I in the previous year please clarify as follows:

"No change in staff particulars from the previous years.

 

ANNEXURE III

 

            The list of documents required to be submitted for the Scheme for Provision or Shelter Houses for looking after the Animals

 

i)          Application in prescribed proforma

 

ii)         The detailed proposal and its justification alongwith gist or existing activities under‑taken and assets acquired

 

iii)         Photocopy of Registration

 

iv)        Memorandum of Association

 

v)         Blue Print/Site Plan duly approved by the local authority

 

vi)        The Certificate that the Organization is in possession of land without any Encumbrances

 

vii)        The estimate for the Shelter House as per proforma

 

viii)       The Certificate that the rates are not more than prevailing PWD/CPWD rates

 

ix)        List of Governing Body

 

x)         Latest Audited Accounts available in four parts duly certified by a Chartered

 

Accountant as follows:

 

a. Audit Report

 

b. Balance Sheet

 

c. Receipt & Payment A/C

 

d. Income & Expenditure A/C

 

 

Ministry of Social justice and Empowerment

 

Name of the Scheme: Provision of Shelter Houses for looking after the Animals.

 

APPLICATION FORM FOR 2nd INSTALMENT

 

1.         Organisation Name                            :

 

Address                                              :

 

Tel. No.                                               :

 

Fax No.                                               :

 

Telex No/E‑Mail No/Grams              :

 

2.         Grant‑in‑Aid (in Rs.)                                      Recurring       Non‑ Recurring          Total

 

A.        Applied in the Current Year              :

 

B.        Received as 1st Instalment                :

 

Amount contributed/spent                 :

by the Organization

 

C.        Applied for 2nd  Instalment                :

 

3.         The applicant Organization should enclose following papers:­

 

(i)         Annual Report. of the previous year.

 

(ii)        Audited statement of accounts of previous year (Receipts and Payments statement and Balance Sheet).

 

(iii)       Audited Utilization Certificate for the V installment/previous installment + 10% share of the Organization on the total cost of the Project with item‑wise expenditure as per the sanctioned norms of grant.

 

(iv)       Assets acquired wholly or substantially out of Government grants under GFR 19 as per Appendix­1.

 

(v)               Any other information considered necessary by the Organization or as asked for

 

Signature                    :

                       

Name                          :

 

Address/Seal              :

 

Dated                          :

 

APPENDIX - I

 

FORM GTR 19

 

[See Government of India's Decision (7) (b) under Rule 149(3)

Assets acquired wholly or substantially out of Government Grants)

 

Register Maintained by Grantee Institution

 

Block Account maintained by Sanctioning Authorities

 

Name of Sanctioning Authority ....................................

 

S. No.      Name of  No. and   Amount   Brief        Whether any condition           Particulars               Value       Purpose   Encumbered            Reasons if                Disposed Reasons   Amount Remarks

                Grantee   Date of    of the       purpose   regarding the right of of           Assets                     of the       for which or not                      encumbered                of or not                 and          realized

Institution Sanction Sancti‑    of the       ownership of Govt.                                actually                   Assets     utilized                                                                                    authority on

oned     Grant    in the property or other             credited or        as on    at present                                                         if any, for disposal

Grant                assets acquired out of the          acquired                                                                       disposal

                                    Grant was incorporated

                                                            in the grant‑in‑aid

                                    sanction

                       

 

 

 

                        Signature:

Place                                                                                        Name of Secretary/President:

Date:                                                                                        Seal of Organization:

 

 

Note:    In case there is no change from the Previous Year a photocopy of the statement of the previous year be furnished with the following statement "No change from the year ............................."

 

 

(Signed)