Annexure

Annexure-I

APPLICATION CUM MONITORING FORM FOR GRANT-IN-AID TO VOLUNTARY ORGANIZATIONS WORKING FOR OTHER BACKWARD CLASSES

(for Ist installment and new cases)

(Training Programmes)

PART - A

1. Financial year for which grant-in-aid is supplied.
2. Name of the Organization
3. (a) Name of the project (b) Date of commencement of project (c) Year of Commencement of Grant-in-aid from G.O.I. for the project. (d) Whether the Project is recognised by the State Government.
4. Date of Registration of the Organization
5. Address of Registered Office	(Ph. No.) (Fax No. ) (E-mail)
6. (a) Complete address of location / locations where programme / project / scheme is being implemented. (b) Nearest Railway Station/Bus stand	(Ph. No.) (Fax No. ) (E-mail)
7. Whether building is OWNED/RENTED ON LEASE/DONATED
8. (a) Is the building utilized exclusively for this programme? (b) If no, provide details of usage
9. (a) Area of building (b) Number of rooms	----------- (in sq.meters)
10. Whether separate project-wise accounts have been maintained for grants sanctioned earlier?	Yes/No
11. Whether principle of joint operation of Bank Accounts is being followed?	Yes/No

12. Details of bank accounts in which grand-in-aid released during last financial year were deposited.
Sl.No.	Grant-in-aid for financial year	sanction letter No.	Dated	Amo-unt recurring	Amt. Non-recurring	Bank A/c No.	Name & Address of Bank	Person operating the A/c
1.
2.
3.
4.
5.
6.

13. Whether the statements of accounts

submitted along with the application. Audited / Un audited

14 Grant-in-aid sought from the

Ministry. : ---------------

Cost Head Group Rs. in lakhs

(a) Recurring

(b) Non-recurring

15. Have you enclosed list of

beneficiaries as per Statement-I : Yes/No

16. Have you enclosed list of

Managing Committee Member

as per Statement-II : Yes/No

17. Have you enclosed the list of

employees as per Statement-III : Yes/No

PART - B

18. Details related to beneficiaries and programmes (separately for each Institution)

(i) Date of :

(a) Commencing Selection Process :

(b) Inviting applicants :

(d) Completion of Selection :

(e) Notification of result :

(ii) Whether any government nominee

actually participated in the selection

process? If yes, the name and

designation of officer. :

(iii) Date of :

(a) Commencement of School

session. :

(b) Completion of School session :

(iv) Details of Beneficiaries:

(a) No. of applicants :

(b) Beneficiaries selected

(Indicating No. of Male &

Female separately :

(d) No. at complete pf Session :

(e) No. of these passed :

(f) No. of dropouts during the year :

(v) Details of Sanction

(a) Letter No. :

(b) Dated :

Non-Recurring :

(d) Amount utilized Recurring

Non-Recurring :

(vi) Name of the Program Coordinator :

(vii) No. of employees involved in the

Program :

(viii) Details about beneficiaries (Please

Indicate no. of beneficiaries against

Each column.

(a) Residential status:

Urban :

Rural :

(b) Educational Level :

Illiterate

Literate :

I - Middle :

II - 10th :

III - 10+2 & above :

(i) Less than Rs. 24,000/- p.a. :

(ii) Rs. 24,000/- to Rs. 50,000/- :

(iii) Above Rs. 50,000/- p.a. :

Reasons for joining the courses :

(i) To become self-employed :

(ii) To become qualified for job :

(iii) To have additional qualification :

(d) Is the Centre assisting the trainees

in jobs/placements : Yes/No

(e) Is the Centre following up the

performance of the trainees after they

successfully completed the course. : Yes/No

19. Have you enclosed the incremental

Income of beneficiaries due to program/

Scheme during the last 3 years preceding

Current year as per Statement-IV : Yes/No

PART - C

12. Details of Income and Expenditure during the year

FOR THE ORGANISATION FOR THE PROGRAM

AS A WHOLE SCHEDULE

Year proceeding receipt of first grant under the scheme at S.No.2.

Previous year

Current year budgeted actual?

Year proceeding receipt of first grant under the Scheme

Previous year

Current year budgeted/actual?

(a) Financial year

(b) Total income of which

(i) funded by office bearer demoting from private sector

(ii) funded by foreign contribution

(iii) funded by local bodies and public sector organisation .

(iv) Funded by State Government

(v) Grant from Central Govt. (please indicate from each ministry / Deptt / CAPART separately)

(vi) Beneficiaries contribution /over charges/students fees.

(vii)Miscellaneous income

(i) Non-recurring

(ii) Recurring

(d) Expenditure onSalaries & Wages

(i) Travelling,daily, etc allowances

(ii) Other Administrative Costs

(iii) Rental

(a) building

(b) Furniture & fixture

(iv) Expenditure on beneficiaries : (a) in cash:

(b) in kind:

(v) Beneficial costs incurred by the orgn;

(a)..................

(b).................

(c).................

(e) Total No. of beneficiaries

(f) Cost per beneficiary:

Statement - 1

Name of the Scheme:

LIST OF BENEFICIARIES

(Including Male & Female in separate statements i.e. 1 (a) & (b)

(i) Name of the Organisation.

(ii) Name and address of the Project.

(iii) Year

S.No.	Name of beneficiary	Father's mother's Name	Date of Birth	Sex	Education. Qualification	Address	Date of entry in institution	Remarks about outcome/results
1.
2.
3.
4.
5.

Secretary/General Secretary

NGO NAME

Statement - II

Name of the Scheme:

Details of Office bearers /Managing Committee of the Organisation.

(i) Name of the Organisation :

(ii) Name & Address of the Project :

(iii) Year :

Sl. No.	Name	Occupation	Address Telephone No.	Educational Qualification
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Sd/-

Secretary/General Secretary

NGO NAME

Statement - III

Name of the Scheme:

DETAILS OF STAFF EMPLOYED IN THE INSTITUTION DURING THE YEAR.

(i) Name of the Organization :

(ii) Name & Address of the Project :

(iii) Year :

Sl. No.	Name & Address	Educational qualification	Date of appointment	Period for which employed during the year	Salary per month	Total salary paid during the year	Remarks

Statement - IV

INCREMENTAL INCOME OF BENEFICIARIES DUE TO PROGRAMME / SCHEME DURING THE LAST THREE YEARS PRECEDING

IMPACT OF PROGRAMME ON BENEFICIARIES

IIIrd year

IInd Year

Ist year

VERIFICATION

Certified that above information is in accordance with the records and accounts audited/ to be audited and is correct to the best of knowledge and belief of the office bearers of the organization, and after its perusal and satisfaction, then they have authorized the undersigned by a resolution dated.................to verify and submit the statement of information for purpose of monitoring the scheme for which grants-in-aid was received from the Ministry of Social Justice & Empowerment, Government of India.

1. I also hereby certify that I have read the rules and regulations of the Scheme and I undertake to abide by them. On behalf of the Management I further agree to the following condition:

(da) All assets required wholly or substantially out of the central grant shall not be encumbered or disposed of or utilized for purposes other than those for which the grant is given. Should the organisation cease to exist at any time, such properties shall revert to the Government of India.

(db) The accounts of the project shall be properly and separately maintained. They shall always be open to check by an officer deputed by the government of India at his discretion.

(dc) If the State of Central Government has reasons to believe that the grant is not being utilized for approval purposes; the Government of India may stop payment of further installments and recover earlier grant in such manner as they may decide.

(dd) The institution shall exercise reasonable economy in its working especially in respect of expenditure on building.

(de) In the case of grant for building, the construction will be completed within a period of two years from the date of receipt of the first installment of grant unless further extension it granted by the government of India.

(df) No change in the Plan of buildings the construction will be made without the prior approval of the government of India.

(dg)Progress reports on the project will be finished at regular intervals as may be specified by the Government.

(dh) The organization will bear 10% of the estimated expenditure or the balance of the estimated expenditure on the project as per the guidelines.

(di) The organization agrees to make reservation for the Scheduled Caste, Scheduled Tribe candidate disabled persons for appointment against the posts required for the working of the organization in accordance with instructions issued by the Government of India from time to time.

(dj) It is hereby certified that no grant is being received for the same project from any other (Government private or foreign) source.

Yours faithfully,

Signature of the Authorized Signatory

Name:

Designation:

Address:

Date:

Office Stamp.

List of documents to be submitted along with Application for Ist Installment for New case.

(a) Accounts in 4 parts for the project for which grant-in-aid is sought and for the organisation as a whole.

(i) Income & Expenditure Statement

(ii) Receipt & Payments Statement

(iii) Balance Sheet

(iv) Auditors Report

(b) Budget estimates for the project for current year

(c) Details of Employees - Proforma

(d) Details of Beneficiaries - Proforma

(e) Details of students from Minorities, OBC, etc

(f) Copy of Registration Certificate

(g) Memorandum of Associates

(h) /bye-laws/Articles

(i) Utilization Certificate in respect of grants released in the previous year

(j) Annual Report

Note 1:- In the case of new project accounts should be the audited version.

Utilization Certificate does not apply. The Audited Accounts and

Annual Report for the last years are to be submitted.

Ministry of Social Justice & Empowerment

APPLICATION FORM FOR IInd INSTALLMENT

(To be submitted in duplicate)

Name of the Scheme........................................

1. ORGANIZATION

Name.........................................

Address....................................

2. Grant-in-aid applied for:

	Recurring	Non-recurring
1. Applied in the current year
2. Received on 1st Installment
3. Applied for 2nd installment

3. Annual Report of the previous year

4. Audited statement of account of previous year:

(i) Receipt and Payment statement

(ii) Income & Expenditure Statement

(iii) Balance Sheet

(iv) Audited utilization certificate with Item wise expenditure

as per the sanctioned items of grant.

5. Amount acquired wholly or subsequently out of Government grants under GFR 19.

6. Any other information on considered necessary by the organization or as asked for.

7. Whether the organization is receiving or expecting to receive any grant

from some other source for the project for which application is being

made?

8. I hereby certify that I have read the rules and regulations of the scheme

and I undertake to abide by them. On behalf of the Management I further agree to the following condition:-

(a) All assets acquired wholly or substantially out of the central grant shall not be encumbered or disposed of or utilized for purpose other than those for which the grant is given. Should the organization cease to exist at any time. Such properties shall revert to the Government of India.

(b) The accounts of the project shall be properly and separately maintained. They shall always be open to check by an officer deputed by the government of India or the State Government. They shall also be open to a test check by the Comptroller and Auditor general of India at his direction.

(c) In the State or the Central Government have reasons to believe that the grant is not being utilized for approved purposes: the Government of India may stop payment of further installments and recover earlier grant in such manner as they may decide.

(a) The institution shall exercise reasonable economy in its working especially in respect of expenditure on building.

(b) In the case of grant for buildings, the construction will be completed within a period of two years from the date of receipt of the 1st installment of grant unless further extension is granted by the Government of India.

(c) No change in the plan of buildings the construction will be made without the prior approval of the Government of India.

(d) Progress reports on the project will be furnished at regular intervals as may be specified by the Government.

(e) The organization will bear the balance of the estimated expenditure on the project or the organization will bear ten percent of the expenditure or the organization will not bear any expenditure and the entire balance will be home by the State Government, and

(f) The organization agrees to make reservation for the Scheduled Caste/Schedule Tribe candidate /Disabled persons for appointment against the posts required for the working of the organization in accordance with instruction issued by the government of India from time to time.

Yours faithfully,

Signature of the Authorized Signatory

Name :

Designation:

Address:

Office Stamp.