02/06/2025, 15:57 NGO Form Details
02 Jun, 2025
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Sudhir Jain
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MADHYA PRADESH
APPLICATION FORM FOR -- GRANT-IN-AID TO VOLUNTARY ORGANISATIONS WORKING FOR THE WELFARE OF
STs/STHRENGTHENING EDUCATION OF ST GIRLS
THIS FORM BE FILLEDUP AS PER GUIDELINES/FINANCIAL NORMS OF EXISTING SCHEMES
NGO Name as registered : MAA PITAMABARA KRASHI SHIKHSA SWASTHA AVA
NGO Unique Id (NITI Aayog Portal): MP/2018/0187534
D 41 PHASE 4 , AMRAVIHAR COLONY ,NAYAPURA KOLAR
Address of Registered office of the RAOD BHOPAL
Organization:
City / Town / Village: bhopal
District: BHOPAL
State: MADHYA PRADESH
Mobile No.: 9179414143
Telephone: -
Email Address: [email protected]
Statute under which the organization is
Registrar of Societies
registered:
Registration Number 06/09/01/07380/10
List of proposal submitted by NGO for financial year 2023-24
Sr. No. Project Id Ack Number Type of Project Nature of Project State District
No Application Submitted!
Acknowledgment No. MP/MP/00001045/ST/01-25/12873
Project State: MADHYA PRADESH Project District: DEWAS
Project Block KHATEGAON Project Village Chichli
Latitude : 22.870941 Longitude : 76.997653
A. Details of Application
1. Financial year for which
2024-25
grant-in-aid is applied:*
2. Sector :* Education Health Livelihood
Nature of the Project:* GIA - Livelihood projects
3. Type of the Project:* New Ongoing
4 Whether NGO/VO has been declared bankrupt at any
Yes No
point of time:
5. Whether the organization has been blacklisted by
Central/State Government or any institution under it, at Yes No
any point of time :
6. Whether any court case filled against MoTA:* Yes No
B. Details of Organization
Registration Details Info. of Current Application Form Info. of Previous
Year's Application
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02/06/2025, 15:57 NGO Form Details
Form
1. Name of the Act under which registered*: 1973 NUMBER 44
2. Date of Registration 27/01/2010 (dd/mm/yyyy)
Whether Registration is for lifetime: Yes No
3. Date of Expiry 10/01/2028 (dd/mm/yyyy)
4. FCRA Registration Number, if any
5. Date of FCRA registration
6. Whether organization is registered under 12A of
Yes No Applied For
income Tax Act*
7. Whether organization is registered under 80G of
Yes No Applied For
income Tax Act*
8. PAN Number* AAHAM2323E
9. TIN/ TAN No.* BPLM18363C
10. Full Name of President of the organization* SWETA SAXENA
11. Full Name of Secretary of the organization* P K SINHA
12. Has the organization changed its name after
receiving the first grant from GOI or from any other
Yes No
Govt. or international funding agency? If yes, give
details and the previous name
Experience of the Organization
Name of Activities Year of First Sanctions
13.Activities being undertaken by the voluntary
a)
organization for the welfare of STs with the support of
b)
Ministry of Tribal Affairs
c)
Name of Activities Year of First Sanctions
14.Activities being undertaken by the organization for
a)
the development of Scheduled Tribes from their own
b)
resources
c)
Name of Activities Name of Ministries/Departments
15.Activities being undertaken by the organization with
a)
support from other Ministries/Departments
b)
16.Any other source including CSR
17. Organization's capability for resource mobilization
Yes No
(indicate sources/amount):
17.(i) In case of yes, indicate amount: 2000000.0
17.(ii) In case of yes, indicate source: NGO
C. Details of Bank Account
1. Whether the NGO/VO have had a Bank Account
Yes No
maintained and operated in the name of Organization
2. Whether it is operated jointly
(Either account should be operated jointly by the
President/Treasure/Secretary of the NGO/VO or by the Yes No
Secretary of NGO and Head of Project in case project
location is different from NGO headquarter)
3. Whether separate project-wise accounts have been
maintained for grants sanctioned earlier under the Yes No
above Scheme as per GFR(235)
Info. of Current Application Info. of Previous Year's
D. Details of Project
Form Application Form
1. Year of commencement of the Project*
2017-18
(Indicate very first year)
2. Complete address of location where project is being implemented
City / Town /
Address : * Address2 Landmark Location Type:
Village:*
Chichli NEAREST VILLAGES VILLAGE khategaon Village
Telephone with STD
PIN Code:* Mobile No. Email of Head of Institution:
Code:
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02/06/2025, 15:57 NGO Form Details
455336 9179414143
Info. of Current Application Info. of Previous Year's
Building Details where project being run / will run
Form Application Form
3. Building Details: * Own Rented
4. Since which year the project is running in this building: * 2018
Info. of Current Application Info. of Previous Year's
E. Project Infrastructure
Form Application Form
1. Whether project is running in a single compact complex. * Yes No
If no, please give details of location of various premises and distances
10
among them.
2. Measurement of whole complex ( in sq.ft.) * 25000.0
2.1 Number of toilets ( separately for boys & girls in case of co-
2(30)
educational institutions) and area *
2.2 Number of bathrooms ( separately for boys & girls in case of co-
2(30)
educational institutions) and area *
2.3 Measurement of kitchen and dining hall ( in sq. ft. )* 500.0
2.4 Number of staff room/office * 3
2.5 Number of class rooms with measurement ( in sq. ft. ) * 3(500)
2.6 Number of laboratories/workshop with measurement ( in sq. ft.)
1(225)
(if applicable)
2.7 Number of dormitories with measurement ( in sq. ft. )* 1(500)
2.8 Any other area not covered above ( in sq. ft)* 15000.0
2.9 Details of courses being conducted* FISH
2.10 Whether warden available* Yes No
2.11 Whether female warden available (if only girls Hostel):* Yes No
2.12 Total Teachers Available ( Numbers Only ):* 5
3. Whether all rooms are properly maintained, white-washed and
Yes No
ventilated *
4. Whether all rooms have electricity and electrical equipments like
Yes No
electric bulb, tubelight, fans etc. *
5. Type of Residents :* Girls Boys Both
6. Maximum number of resident per room/dormitory in hostel being
25
accommodated
7. Provision for clean and safe drinking water * YES
Facilities in hostel:
8. Whether all students/residents have separate beds with bedding
Yes No
material*
9. Whether they have been provided soap,washing powder etc.* Yes No
10. Whether the school/Hostel has provided kitchen, cook and food
Yes No
stock to provide diet to students/residents:*
F. Grant-in-aid sought from the Ministry
1. No. of beneficiaries of previous year:* 120
2. Specify the number of beneficiaries for which grant is applied: * 120
Project Description
We will set up ornamental fish units and provide
1. Give Description about your project along with courses being training to tribal villagers. Our team will establish the
unit and train them. They will be able to rear
conducted ornamental fish. We will also provide fish seeds. We
will buy back the fish, too.
1 YEAR
2. Give duration of diff. courses conducted
Cost sort during the year Rs. in Lakhs
(a) Recurring 10.86
(b) Non-recurring 139.41
(c) Total 150.27
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02/06/2025, 15:57 NGO Form Details
VERIFICATION
1. Certified that above information is in accordance with the records and accounts audited by a registered Chartered
Accountant and is correct to the best of knowledge and belief of the office-bearers of the NGO/VO, and after its perusal
and satisfaction, they have authorized the undersigned by a resolution dated 01/06/2024 (dd/mm/yyyy) to verify and submit
the statement of information for purposes of monitoring the scheme for which grants-in-aid was received from the Ministry
of Tribal Affairs, Govt. of India.
I undertake to abide by the conditions mentioned in the guidelines.
Name of Authorised Person: sidharth sinha
Contact Number: 9179414143 (e.g. 0296512345678)
Date: 01/02/2025 (dd/mm/yyyy)
Time: 1:51 PM
Place: BHOPAL
Document Uploaded By NGO
S.No Document Name View File
1. Certified copy of the Registration Certificate under Societies Registration Act, 1860 or Charitable Trust Act etc. View
2. Memorandum of Association and copies of rules, aims and objectives of the organization View
3. Budget Estimates for the project for current year with detailed justifications for various cost items View
4. Details of authorized signatories operating the bank account duly authenticated by Bank Authority (in prescribed format) View
List of beneficiaries for previous / current financial year. Incase of hospital please provide number of ST Patients of
5. View
OPD,Indoor,Total Male,Total female
List of Employee engaged in the project showing their name, designation and category of staff (SC/ST/OBC) engaged by
6. the organisation giving complete address as in photo I card issued by Election commission/Adhar number(As per prescribed View
Form VI)
Surety Bond (Blank) on Non-Judicial Stamp paper of Rs.20l- duly signed & stamped by authorized signatory on every page
as well as signed by 2 witnesses indicating name and addresses is required (in original) along with the resolution of the
7. View
Governing Body of the organization (in prescribed format). Surety bond (in original) a/w resolution of the Governing Body
of the organization also be forwarded to the Ministry through post.
8. List of Management/Managing Committee Members and its Validity (in prescribed format) View
9. Activity/Annual Report of the the organisation for the last two years View
Audited accounts in 4 parts for the project and for organisation as a whole for which grant-in -Aid is sought and for which
10. grant is applied for previous year (i) Income & Expenditure Statement (ii) Receipt & Payment Statement (iii) Balance Sheet View
(iv) Auditors Report along with Honorarium break up
11. Memorandum of Bye-Laws of the organization View
12. Authorization Letter duly attested by Bank Authority (in prescribed format) View
13. Acceptance of terms and conditions (duly signed on each page) View
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