MUNUICIPAL CORPORTION OF HYDERABD URBAN COMMUNITY DEVELOPMENT BALIKA SAMRUDDHI YOJANA APPLICATION FOR POST DELIVERY GRANT Photograph of the Mother with the Child 1. .Name of the Applicant / Mother : 2. Name of the Husband : 3. Name of the Girl Child : 4. Occupation : a. Father b. Mother c. Caste 5. Date of Birth / Age of the Child : (Proof of age to be produced Municipal Record Certificate) 6. Address : 7. No.of Girl Children : 8. Place of Birth (Enclose Delivery/Birth Certificate) : 9. Present family income per month : 10. Whether Previously applied/availed Of the benefit, if so from whom : 11. Remarks : DECLARATION I declare that I have not benefited previously the Post Delivery Grant under NMBS and BSY any other scheme. The above information is true to the best of my knowledge. Any information noticed as false, I shall be liable for any action. DECLARANT / APPLICANT GUIDELINES TO STAFF FOR B.S.Y., SURVEY NON-ECONOMIC PARAMETERS Parameter Weightage Score for each Attribute (A) (B) (C) (D) (E) (F) a) LIVING CONDITION i. Room Thatch Tarpaulin Asbestos Wooden Tiles Cement ii. Floor Earthern Bajri Bricks Cement Chips Stone/Marble iii. Water No Water Community Community Private privte private piped supply for handpump tubewell handpump tubewell water supply yards iv. Sanitation Open Community Community Private Private Private Flush Defecation Dry Laterine Pour Flush Dry pour Laterine with Laterine Laterine Flush sewer connection b) EDUCATIONAL Illiterate Primary Middle Matric 10+2 Graduate pass LEVEL pass pass pass pass c) TYPE OF Unskilled Semi Skilled Self Own Own Organised EMPLOYMENT Casual Employed Work Work Sector with Labourer/ Street/push Place Place & Social security Unemployed Cart Selling Place d) STATUS OF Working Working Working Children Children Children not CHILDREN IN A Children & Children but Children not not working working HOUSE not attending attending but working and attending as well as Any school/ school/NFE/ attending as well as school/NFE/ attending NFE/Literacy Literacy School/NFE/ attending Literacy school/NFE Classes Classes Literacy any classes Literacy sometimes Classes classes sometimes classes Regularly Regularly 1. Two girl children from each family will be eligible under B.S.Y. 2. Date of Birth of the Girl Child should be on or after 1-8-1999 only 3. Preference will be given to those of who have undergone Family Planning Operation 4. Birth Certificate from Municipal Officer should be enclosed. 5. The application should be confirmed by the Anganwadi Teacher/RCV's/NHC's convenor. 6. The application should belong to the Below Poverty Line category as defined by Government of India guidelines. Project Officer /Dy.Project Officer will select the poorest of the poor as determined from the Non-Economic parameters (as mentioned above) 7. Poorest of the poor must be selected. OFFICEPURPOSE Verified the details of the applicant. She is eligible for sanction of Post Delivery Grant. Her application is recommended / rejected. Reasons of Rejection : PROJECT OFFICER / DY.PROJECT OFFICER U.C.D., CIRCLE NO. ,MCH.
