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 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 6. (a) Complete address of location / locations where programme / project / scheme is being implemented. (b) Nearest Railway Station/Bus stand 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 10. Whether separate project-wise accounts have been maintained for grants sanctioned earlier? 11. Whether principle of joint operation of Bank Accounts is being followed? (Ph. No.) (Fax No. ) (E-mail) (Ph. No.) (Fax No. ) (E-mail) -----------(in sq.meters) Yes/No Yes/No Cost Head Group Rs. in lakhs (a) Recurring (b) Non-recurring (c) Total 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 : (c) Closure of applications : (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 : (c) No. at beginning of Session : (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 : (c) Amount sanctioned Recurring 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 : (c) Family Income: (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 (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 (c) Total Expenditure (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 Year Previous Current year proceeding year budgeted receipt of first actual? grant under the scheme at S.No.2. Year proceeding receipt of first grant under the Scheme Previous year Current year budgeted/ actual? (c) Plant & machinery (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. 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 : 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 : Statement - IV INCREMENTAL INCOME OF BENEFICIARIES DUE TO PROGRAMME / SCHEME DURING THE LAST THREE YEARS PRECEDING 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 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: 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.
