APPLICATION CUM MONITORING FORM FOR GRANT-IN-AID TO VOLUNTARY ORGANISATIONS WORKING FOR OTHER BACKWARD CLASSES (for Ist instalment and new cases)(Training Programmes) PART-A 1. Financial year for which grant-in- aid is applied 2. Name of the Organisation 3. (a) Nature of the project (b) Date of commencement of the 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 Office6. (a) Complete Address of Location / Locations where Programme / Project / Scheme is being implemented. (b) Nearest Railway Station / Bus stand 7. Whether building is:8. (a) Is the building being utilized exclusively for this program ? NOYESOWNEDRENTEDONATEDON LEASESTD Code Tel. No Fax No.EmailSTD Code Tel. No (b) If no, provide details of usageAnnexure-I 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? 12. Details of bank accounts in which grant-in-aid released, during last financial year were depositedSl. No Grant-in- aid for financial year Sanction letter number and Date Recurring Amount Non- recurring Amount Bank A/c No. and date of deposit Name and address of Bank Person Operating the joint Account 13. Whether the statements of accounts submitted along with the application 14. Grant-in-aid sought from the Ministry (Rs. in Lakhs) Cost Head Group (a) Recurring (b) Non-Recurring(c) Total 15. Have you enclosed List of Beneficiaries as per Statement-I NOYESAUDITEDUNAUDITED16. Have you enclosed List of Managing Committee Members as per Statement-II 17. Have you enclosed the List of Employees as per Statement-III Sq. mtrs PART-B18. Details related to beneficiaries and programmes (separately for each Institution) (i) Date of : (a) Commencing Selection Process (b) Inviting applicants (c) Closure of applications (e) Notification of result (d) Completion of Selection (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 completion of Session (e) No. of those 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 YESNO MaleFemale (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 - Rs. 50,000 p.a. (iii) Above Rs. 50,000 p.a. (d) Reasons for joining the courses : (i) To become self-employed (ii) To become qualified for job (iii) To have additional qualification (e) Is the Centre assisting the trainees in Jobs / Placements(f) Is the Centre following up the performance of the trainees after they successfully completed the course 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 NOYES PART-C20. Details of Income and Expenditure during the yearFOR THE ORGANISATION AS A WHOLE FOR THIS PROGRAM SCHEMEParticulars Previous Year Current Year Budgeted / actual ? Previous Year (a) Financial year (b) Total Income, of which (i) funded by office-bearers, donations from private sector (ii) funded by foreign contribution. (iii) funded by local bodies and public sector organization (iv) funded by State Government (v) Grant from Central Govt. ( please indicate from each Ministry / Deptt / CAPART separately). (vi) Beneficiaries Contribution/ User Charges / Student fees (vii) Miscellaneous income Year Precending receipt of first grant under the Scheme at S.No.2 Year Precending receipt of first grant under the Scheme (c) Total Expenditure, of which (i) Non-Recurring (ii) Recurring (d) Expenditure on (i) Salaries & Wages (ii) Traveling, daily etc. Allowances (iii) Other Administrative Costs (vi) Rental (a) Building (b) Furniture & Fixture (c) Plant & Machinery(v) Expenditure on Beneficiaries (a) In Cash (b) In Kind(vii) Material costs incurred (For imparting Vocational Training etc. ) (e) Total no. of beneficiaries (f) Cost per beneficiary 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, 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, Govt. of India. 2. 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:- (a) All assets acquired wholly or substantially out of the central grant shall not be encumbered or disposed of or utilized for purposes other then 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. (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 at his discretion. (c) If the State or Central Government has reasons to believe that the grant is not being utilized for approved purpose; the Government of India may stop payment of further installments and recover earlier grant in such manner as they may decide. (d) The institution shall exercise reasonable economy in its working especially in respect of expenditure on building. (e) 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 first installment of grant unless further extension is granted Government of India. (f) No change in the Plain of buildings, the construction will be made without the prior approval of the Government of India. (g) Progress reports on the project will be furnished at regular intervals as may be specified by the Government. (h) The organisation will bear 10% of the estimated expenditure or the balance of the estimated expenditure on the project as per the guidelines. (i) The organisation agrees to make reservation for the Scheduled Casts, Schedule Tribe candidate / Disabled persons for appointment against the posts required for the working of the organisation in accordance with instructions issued by the Government of India from time to time. (j) It is hereby certified that no grant is being received for the same project from any other (Govt. private or foreign) source. VERIFICATIONSignature of the Authorised Signatory Name AddressDate Office StampYours faithfully,Designation Ministry of Social Justice & Empowerment APPLICATION FORM FOR 2ND INSTALMENT (To be submitted in duplicate) 1.ORGANIZATION 2. Grant-in-aid applied for : Recurring Non-Recurring Total 1. Applied in the current year 2. Received as Ist installment3. Applied for 2nd Installment 3. Annual Report of the previous year4. Audited statement of account of previous year :(i) Receipt and Payment statement (ii) Income & Expenditure Statement (iii) Balance Sheet(iv) Audited utilisation certificate with Item wise expenditure as per the sanctioned items of grant. 5. Assets acquired wholly or substantially out of Government grants under GFR 19 6. Any other information 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 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. (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 discretion. Name of the SchemeNameAddress YESNO (c) If 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. (d) The institution shall exercise reasonable economy in its working especially in respect of expenditure on building. (e) 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. (f) No change in the Plan of buildings, the construction will be made without the prior approval of the Government of India. No change will be made in the project location and timings without convincing reasons and prior approval of the Ministry. (g) Progress reports on the project will be furnished at regular intervals as may be specified by the Government. (h) The organisation will bear the balance of the estimated expenditure on the project or the organisation will bear ten percent of the expenditure or the organisation will not bear any expenditure and the entire balance will be borne by the State Government; and (i) The organisation agrees to make reservation for the Scheduled Casts / Schedule Tribe Candidate / Disabled persons for appointment against the posts required for the working of the organisation in accordance with instructions issued by the Government of India from time to time. Signature of the Authorised Signatory Name AddressDate Office StampYours faithfully,Designation
