ANIMAL WELFARE BOARD OF INDIA

13/1, Third Seaward Road

Valmiki Nagar, Thiruvanmiyur, Chennai - 600 041

Phone : 044-2445 4958, 2445 4935  Fax : 044-2445 4330

E-mail : awbi@md3.vsnl.net.in  Website : www.awbi.org

 

Name of the Scheme :      Scheme for Animal Birth Control & Immunization of Stray Dogs

 

Application form for new proposal for the year

 

 

1.       Organisation Name                                       :

          Full postal address with pincode                   :

 

 

 

          Tel/Mobile No.                                                :

          (Including STD Code Number)

          Fax No.                                                          :

          E.Mail/ Grams                                                :

          Nearest State Bank of India                           :

          Branch and its Code No.

 

          (i)    Name of the Act under                           :

                  which Registered                                      

          (ii)    Registration No. and                              :

                 date of Registration                                   

                 (Please attach a photocopy)                 

          (iii)   AWBI Recognition Code No.                  :

2.       Whether Govt. body/Municipality/                  :

          Local body/NGO give details                            

 

3.       Registration under Foreign                            :

          Contribution Act                                                                        

4.       Memorandum of Association                         :

          and Bye-Laws

          (Please attach a photocopy)                            

5.       Name and address with phone                     :

          Nos. of the Members of

          Managing Committee/Executive

          Committee/Governing body                          

          (Please attach separate sheet)                    

 

6.       Details of previous grants for the                  :

          last 3 years received from the Board           

 

 

7.       Details of accounts/UC pending                    :

          with you, if any, yearwise.

 

                                                                                               

8.       Details of last inspection done                      :

          (Date & inspection details)

 

 

9.       Details of ABC indicating the                         :

          number of animals to be sterilized

          and immunized in the current

          year and total expenditure                                

          to be incurred for the purpose                      

 

10.     Grant in aid applied for the year                     :

11.     Details of Grant-in-aid                                    :

          received from any other

          Agency/Govt./Dept, if any

          for the same purpose                                                   

 

12.     Details of ABC operations                             :

          carried out in the last 2 years                                                   

13.     Details of infrastructure/facilities                   :

      available with the organization to

      implement the proposed scheme

 

      (a)        Whether you have grazing land            :

                  and Animal Shelter

 

          (b)    Whether you have a Dispensary          :

                  with operation theatre                                                        

  

          (c)    Whether Veterinary Surgeon                :

                  is available                                                                       

            If yes, full time/part time/

            Weekly etc.

 

      (d)        Whether you have para veterinary        :

                  staff, animal handlers, medical

                  equipment                                            

          (e)    Whether you have autoclave                :

       (f)        What is the source of supply                :

                   of dogs, if caught and relocated

                   by NGO itself then certificate

                   as given in Sl.(m) of Annexure

                   to be furnished.                                                                

          (g)    Whether you have your own                 :

                  dog catchers                                                        

 

          (h)    What is your capacity to do ABC          :

14.     Whether adequate water supply                   :

          is available and existing  system

          of drainage.

15.     Does the Organisation have an                     :

      Ambulance?                                                                     

      a)         If yes its make and size

                  How the recurring expenditure

                  is met?                                                 

      b)         Is the driver employed permanent/

                  temporary/as required basis.

16.     Whether entered into MoU with                     :

          Municipality/Corporation.  (Copy

          Of MoU to be enclosed)

17.     Whether you have undertaken a                   :

      dog population survey in your area

18.     Who are the other collaborating                    :

          AWOs in this project?                                                  

19.     How the recurring expenditure                      :

          is met?                                                                                      

20.     What are your animal welfare activities        :

21.     List of additional supporting papers,              :

          if any given:

I/We have read the scheme and fulfill the requirements and conditions of the scheme.  I/We undertake to abide by  all terms and conditions of the scheme.

 

Signature                               :          

Name                                    :           

Address/Seal                        :

Dated                                    :

 

Note   :    Wherever not applicable, especially in case of new Organisations,  please write N.A.

 

ANNEXURE

Documents to be attached with ABC proposal

a)      Application in prescribed proforma

b)      The detailed proposal and its justifications alongwith gist of activities undertaken and assets required

c)      Details of area to be covered for this programme, total dog population in this area duly certified by the concerned Municipal Corporation(s); method adopted for carrying out dog census and how and in what time the organization will complete the programme in this area.

d)      Photocopy of Registration

e)      Memorandum of Association showing “Animal Welfare” as one of its objectives

f)       The estimated cost of proposed immunization and sterilization of dogs along with number of dogs and the area to be covered

g)      List of Governing Body

h)      Audited Account of last three years duly certified by a Chartered Accountant i.e. Audit Report, Balance Sheet, Receipt & Payment Account and Income & Expenditure Account.

i)        Details of infrastructure viz. Operation Theater, Kennels (with their capacity), Vet. Surgeon, Vehicle, man-power etc. available to implement this project

j)        Details of activities undertaken in the field of Animal Welfare both in physical & financial terms during last three years

k)       Details of financial assistance, if any, received from any other agency for this purpose

l)        Details of collaborative arrangement that exist between the concerned local body and the NGO to implement the project and a copy of Memorandum of Understanding entered into with every concerned Local body

m)     If the AWO is making its own arrangement for catching and re-location of dogs, a certificate from the local body that they are not providing this service is to be furnished.

n)      Photocopy of documents/certificates should be submitted duly attested by Gazetted officer or Notary.

 

---