Annexure-B Utilisation Certificate ... I have verified the accounts of ____________________ in respect of the grants of Rs._________________ released by the Department of Women and Child Development/Central Social Welfare Board for the period ___________________ with the help of vouchers and certify that they are correct and that an amount of Rs.______________________ has been utilized upto ________________ for the purpose for which it was sanctioned. The balance of Rs._____________________ remaining unutilized at the end of the year has been surrendered to the Govt. (vide No.________________ dated __________________)/ will be adjusted towards the grant-in-aid payable during the next year__________________. (CHARTERED ACCOUNTANT) Annexure-A CENTRAL SCHEME OF ASSISTANCE TO VOLUNTARY ORGANISATIOS FOR CRECHES APPLICATION FORM Note (Application received in an incomplete form will not be entertained.) PART - I (To be completed by the applicant) 1. Name of the Institution/organization: Objectives of the Institution/Organization: 3. Brief history of the Institution/Organization and its objects and activities: 4. Whether recognized by the State Government: 5. Whether registered under Indian Societies Registration Act, 1860 (ACT XXI of 1860) 6. Whether the institution/organization is of all India character. If so, give the nature of its all-India character: 7. Whether located in its own/rented building: 8. Present number of beneficiaries (i.e. babies in the age group of 0-6 years) and the number of creches run by the organization. 9. Details of the cr ches project for which grant is applied (i.e. the number of additional babies to be provided with care in the existing creches, additional creches proposed to be started, the nature of baby care service to be provided, item-wise details of estimated expenditure etc.): 10. Likely dates of commencement and completion of the cr che project: 11. Whether the project is likely to be assisted by some other official or nonofficial sources. If so, give details thereof: 12. Justification for the project indicating its important features which entitle it to central assistance (mentioned the name of the work etc.; the working mothers which will be benefited, and give any other relevant information): 13. Total estimated expenditure on the project for one year: (a) (i)Non-recurring ________________Rs. (ii) Recurring ___________________Rs. (b) Period for which recurring assistance is required: 14. a) Amount of grant requested (not exceeding 90% of the estimated expenditure); a) i) Non-recurring ________________Rs. ii) Recurring ________________Rs. b) Period for which recurring assistance is required: 15. Is accommodation available for running the creches to or temporary shelter is proposed to be improvised? 16. Whether the institution is in a position to meet 10% or balance expenditure? If so, indicate the sources: 17. List of papers/statements to be attached (in duplicate): a) Prospectus/Memorandum of Association or a note giving aims and objects of the institution/organization: b) Constitution of Institution/Organization: c) Constitution of the Board of Management with brief particulars of each member: d) Latest available annual report: e) Audited accounts for last two years along with a copy of their certified balance sheet for the previous year: f) A statement giving details (year, purpose, amount etc.) of assistance received during the last two years from the Central/State Government, Central Social Welfare Board, local bodies or any other quasi-Government institutions including requests made there of to any one of these or any other organization for the project under consideration or for any other project: g) A statement giving item-wise and year-wise details of estimated recurring and non-recurring expenditure on the proposed creche project: 18. List of additional papers, if any: 19. Additional information, if any: 20. Does the institution/organization work of profit to any individual or body of individuals? Signature of Secretary/President.
