Government of India Department of Women and Child Development) Central Scheme of Assistance for Construction/ Expansion of Hostel Building for Working Women with a Day-Care-Centre. SUPPLEMENTARY TO THE APPLICATION FORM PART.I Note: Application received in an incomplete form or after the prescribed date will not be entertained. (to be completed by the applicant) 1. Name of Organisation/ Institution 2. Brief History of organisation/ institution and description of its objects and activities. 3. Whether recognised by the State Government 4. Whether the organisation/ institution is registered under Indian Societies Registration Act, 1860 (Act XXI of 1860) or corresponding State Acts, or it is managed by a Trust or Body of Trustees. (Details of registration with the name of Act). 5. Whether the organisation/ institution is managed by Central Government/ State Government or Local Body. 6. Whether the organisation/ institution is of All India Character, if so, give the nature of its All India activities. 7. Whether organisation/ institution has already a hostel, if so, whether in its own or a rented building stating number of inmates 8. Number of working women for whom hostel is intended to be constructed and also the number of the pre school children for whom the Day Care Centre is proposed. 9. Likely date of commencement and completion of hostel building. 10. Whether the project is likely to be assisted by some other official or non official agency. If so, their name and the extent of assistance proposed to be provided by each may be indicated. 11. Justification of the project indicating the outstanding features which entire it to Central Assistance. 12. (a) Total estimated expenditure on the project (b) Amount of grant required from the Government of India. ( c) Source (s) from which the balance expenditure is proposed to be met. 13. Whether necessary land for the proposed building is available if so, give details in India (location and area) with evidence for ownership. 14.(a) Details of plinth area to be constructed in relation to the number of working women for whom construction to be undertaken including number of rooms with capacity, number of floors toilets and common facilities. (b) Whether plinth area is according to the standard laid down by the State Government/ Local Administration for similar projects. ( c) Whether trained staff and other suitable facilities for undertaking construction are available if so give details. 15. Whether the institution/ organisation is in a position to meet the balance expenditure, if so, indicate the source (s). 16. List of papers/ statements to be attached. a. Prospectus of the Voluntary Organisation/ Institution of a brief description of its objects and activities. b. Constitution of the organisation/ institution. c. Constitution of the Board of Management and the particulars of each number. d. Copy of the latest available Annual Report. e. Detailed structural financial estimates of the hostel building, giving item-wise details of recurring and non recurring expenditure and the sources from which the remaining funds will be obtained. f. Information relating to the grant received from promised by or the requests made to other bodies, e.g. State Governments, Local Bodies etc. for the construction of the proposed hostel building. The decisions of these bodies on such requests would be communicated to them. g. A statement of the full receipts and expenditure of the voluntary organisation/ institution for the last two years and a copy of the balance sheet for the previous year certified by authorised Auditors / Chartered Accountant. h. A copy of site plan of the proposed hostel building with a certificate from the local municipal authorities that the construction of the building has been permitted. i. A certificate to the effect that the rates of construction to be adopted are not in excess of the scheduled of rates of the PWD of the State concerned duly countersigned by the Head of the State PWD concerned or its nominee. j. Documentary proof of ownership of plot on which the hostel is proposed to be constructed. 17. List of additional papers, if any. 18. Additional information if any (Signature) (Name in Block letters) Date of Designation Office Stamp.
