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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 : Provision of Shelter Houses for looking after
the animals
Application form for new proposal
1. Organisation Name :
Address :
Tel. No. :
Fax. No. :
Telax No./E-Mail No./Grams :
(i) Name of the act under which registered :
(ii) Registration No. and date of Registration :
(Please attach a photocopy)
2. Any other Organisation/Instt./Body :
if applicable, give details
3. Registration under Foreign Contribution Act :
4. Memorandum of Association and Bye-Laws :
(Please attach a photocopy)
5. Name and Address of the members of the :
Board of Management/Governing Body
6. Availability of Land : The following information :
may be furnished:
(i) Land Area :
(ii) Location of Land for Shelter House :
(iii) Whether the land is registered in the name :
of the Org.
(iv) If the land is registered in the name of the :
Org.
(a) Whether it is available on long term :
lease
(b) Whether, revenue records are available :
if the land is donated by Panchayat or
any other Person/body
(c) Any other status of land such as :
Registered/Special Power of
Attorney etc.
(v) A Blue Print/Site Plan duly approved by :
the local authority/approved valuer
(vi) The Certificate that the Organisation is in :
possession of land without any
Encumbrances
7. A copy of the Annual cum Progress Report :
and Audied Annual Accounts for the
previous year (s) which should contain the
Balance Sheet, Income & Expenditure A/c
and Receipt & Payment A/c.
8 (a) Budget Estimates for construction of :
Shelter House to be furnished as per
following items.
Sl.No. List of Items Maximum amount
admissible*
(Rs. in Lakhs)
1. Cost of boundary wall with man proof fencing 3.00
2. Cost of construction of in house dispensary 3.00
3. Cost of Medical equipment 1.25
4. Cost of construction of shelters 13.00
5. Cost of construction of water tank (s) 1.75
6. Cost of construction of drains 1.75
7. Contingencies 1.25
Total 25.00
* The item-wise amount indicated above is the maximum entitlement for the construction of Shelter House but the actual entitlement will be calculated as per requirement of the Organisation on the basis of particulars furnished.
(b) The Budget Estimates are required to be prepared by CPWD/State PWD/Approved Valuer alongwith the Certificate that the rates are not more than the prevailing P.W.D. schedule of rates for similar work.
(c) The Organisation is required to contribute minimum 10% of the total cost of the project.
9. Details of Beneficiaries/facilities available with the Organisation as per Annexure I
10. Details of Staff Employed as per Annexure II
11. List of documents to be attached as per Annexure III
12. List of additional 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 the conditions of the Scheme.
Signature :
Name :
Address/Seal :
Dated :
Note : Wherever not applicable, especially in case of new Organisations, please write - N.A.
Name of the Scheme :
Details of Beneficiaries/Facilities available with the Organisation
(i) Name of the Organisation :
(ii) Name and address of the Project :
(iii) Year/Previous Year :
Detail of Beneficiaries
Type of animal No. of animals Male Female
Details of Facilities available
1. Whether the Organisation has in-house dispensary? Yes/No
2. Whether the Services of the Veterinary Surgeon available? Yes/No
If yes, full time/part time/weekly etc.
3. Whether First-aid facility to animals available? Yes/No
4. Whether the Organisation have any Bio-gas plant? Yes/No
5. Whether facility for adequate water supply exists? Yes/No
If yes, indicate the source thereof
6. Whether necessary drainage system exists? Yes/No
7. Whether the organisation has got necessary resources to
maintain the animal shelter. If yes, give details Yes/No
Annexure II
Details of the Staff Employed
Part I (Previous Year)
(i) Name of the organisation :
(ii) Name and address of the Project :
(iii) Year
Sl. Name and Educational Date of Period for Salary per Total Remarks
Address Qualification Appointment which employed month salary paid
during the year during the
Year
Part II (Current Year)
(i) Only notify change from the previous year
(ii) In case there is no change in the part I in the previous year please clarify as follows:
“No change in staff particulars from the previous years’.
Annexure III
The list of documents required to be submitted for the Scheme for Provision of Shelter Houses for looking after the animals
1) Application in prescribed proforma (copy enclosed)
2) Detailed proposal and its justification for construction of the shelter house;
3) Authenticated copy of the Registration Certificate in respect of the organization (certified by the Registrar);
4) A copy of the Memorandum of Association;
5) Site Plan/Blue Print duly approved by the local authorities;
6) Registered lease/gift/sale deed. Lease deed should be for a period of minimum 30 years;
7) Attested copy of Revenue Record of land showing its title in the name of organization;
8) A certificate from the concerned Registrar/Sub Registrar along with documentary proof that the land on which shelter house is proposed to be constructed is in the name of the organization and without any encumbrances;
9) The estimate showing the amount of financial assistance required for construction of shelter house in relevant break-ups worked out and authenticated by an approved valuer;
10) A certificate from the State Government Approved Valuer to the effect that the rates quoted for the construction of the proposed Shelter House are not more than prevailing PWD/CPWD rates;
11) List of governing body;
12) Latest audited statement of accounts duly certified by the Chartered Accountant, in respect of the organization for the last financial year, in the under mentioned parts:-
(i) Balance Sheet (ii) Income & Expenditure Statement (iii) Receipt & Payment Statement and (iv) Audit Report;
13) Details of Animal Welfare activities performed so far and expenditure incurred for this purpose;
14) Details of financial resources to run the proposed shelter house smoothly and area to be covered for rescue of animals;
15) Details as to whether the organization has ever received any grant-in-aid from the Ministry or AWBI and if so, please indicate whether the Utilisation Certificate of that grant has been submitted or not;
16) Quotation in support of cost of medicines/medical equipments required;
17) Details of existing covered/constructed area, its capacity and proposed to be covered;
18) Copy of Memorandum of Understanding/Agreement entered into with concerned local bodies (i.e. Municipal Corporation, Panchayat etc.) to the effect that the organization will accept stray animals from them to the extent of sheltering capacity for which the grant is sought;
19) All original documents in regional language should be furnished with an attested translated version in English/Hindi.
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