Animal Welfare Board of India
(Ministry of Environment and Forests, Govt. of
India)
Post Box No. 8672
13/1, Third Seaward Road, Valmiki Nagar, Thiruvanmiyur,
Chennai - 600 041.
Email
: awbi@md3.vsnl.net.in website:www.awbi.org
APPLICATION
FOR FINANCIAL ASSISTANCE
(REGULAR
GRANT) TO ANIMAL
WELFARE ORGANISATIONS FOR THE YEAR 200 - 200
I. a) Name,
address with pincode of the organisation :
b) Telephone,Mobile,Fax,E-mail :
c) AWBI Recognition Code No. :
d) Main activities of the organization :
e) Bank Name, Branch. Account No. and :
Bank
IFSC Code No.
(Details to be certified by Bank as
per the
enclosed format)
2.
Grant received/Income during the previous
financial year 200
- 200
:
(1) AWBI
Grants (Scheme wise details –
Regular Grant, Shelter, ABC,
Ambulance, Natural Calamity)
(2) State Government
(3) Central Government :
(4) Foreign
Agencies :
(5) Donations :
(6) Rent, sale of Gaushala/AWO products etc.:
(7) Total: Receipts/Income (1-6) :
3. Details of Fixed
Deposits, Bonds etc.
4. Audit Report for the past three years :
(to be enclosed separately)
5. Annual Report/Activity Report for last years:
6. Component of the Regular Grant proposed :
to be
undertaken for which financial assistance
required from the AWBI for the current financial
year (200 - 200 )
a) Maintenance/Repairs of Rescue Home
:
for Animals
b) Construction of Water Troughs/Facilities :
c) Rescue operation during natural :
calamities including maintenance of
stray animals
d) Purchase of Medicines for animals :
e) Purchase of Medical Equipment :
f) Establishment charges – cost of
:
engaging Veterinary Doctors, Inspectors,
Veterinary Assistants, Compounders,
Ambulance Drivers etc. (details may be
furnished)
g) Creation of infrastructure for
generation of :
biogas, bio-fertilizer, draught
power,
electricity from biogas
(maximum 25% of total Regular
Grant sanctioned)
h)
Total
:
7.
Other particulars required for
:
considering Financial
Assistance
a) Whether land available – If
yes, :
give details of extent, Survey No., etc.
(attach copy of title deed)
b) Whether facilities of Veterinary Hospital/
:
Dispensary available - If yes, specify
whether Dispensary or Hospital. Give
details of no. of cases treated per day.
Separate detailed note may be attached
c) Whether vehicles, Tri-wheeler,
Ambulance
:
or Mobile Animal Clinic available - If yes,
specify number of vehicles and make
& model; whether given by Ministry/Board
If so, give year of
sanction/purchase details
d) Whether Animal Shelters are available -
:
If yes, specify number of sheds and
constructed area of the Shelters;
Whether grant given by Ministry/Board
If so, give year of
sanction/construction details
e) No. of animals maintained in the :
Shelter
(s) as on date duly verified by a Board/
Co-opted Member AWBI/Government Veterinary
Officer of Animal Husbandry Dept. with
his name,
address, telephone no. given in detail)
No bird
should be kept in captivity and as such not eligible for any grant.
|
Cows |
Buffal oes |
Milchi ng animals |
Ox/ Bullo cks |
Male Calves |
Female Calves |
Hors es |
Donk eys |
Sheep/ Goat |
Cats/ Kittens |
Dogs/ Pupp ies |
Other animals (specify category) |
Total |
|
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|
|
|
|
|
|
|
|
|
|
|
|
Total number of animals as on 31.3.________ :
Total Number of animals as on 31.3.________ :
Average Number of animals sheltered during the year :
Total Number of animals which died during the previous year :
f)
No. of milching
animals
:
g) Income from Sale of Milk :
h)
No. of Animals treated during the year :
(Duly
verified by a competent Govt. Veterinary Officer/A.H. Dept.
with
his name, address, telephone and seal in detail)
i) No. of cases booked and prosecuted :
and the details of fines realized from
the Court
j) Whether any animal rescued from illegal
transportation in the previous :
year and if yes, then copy of the
FIR/Magistrate/Collector/Municipal
Corporation may be enclosed and
expenditure incurred on it
including litigation may be given
in detail
8. Copy of audited statement of accounts :
and utilisation certificate for the previous
year
9. In case the AWO is doing prosecution/ :
awareness work, please give details
10. Name, address, telephone nos./ :
mobile no. and e-mail address of the
President/Secretary/Manager of the
AWO be given separately with full details
PRESIDENT SECRETARY
(Signature with Name and seal)
THE FOLLOWING DOCUMENTS/INFORMATION
TO BE SUBMITTED WITH THE APPLICATION – INCOMPLETE APPLICATIONS WILL NOT BE
CONSIDERED FOR GRANT
- Application Fees of
Rs.100/- in the form of DD in favour of Secretary, Animal Welfare Board of
India, payable at Chennai may be sent.
- Application should be
filled completely. It should contain all annexures
I to IV as enclosed. Any incomplete application or without annexures will not be processed further. - An Undertaking to the
effect that the organization should not dispose off male calves by sale/auction
etc. and instead castrate them if not used for breeding purposes. The organization should keep a record
of all male calves and if the male calves are given to the farmers for use
in agricultural operations, then an undertaking will be taken from the
farmers that they will not sell the calves to anybody (Annexure I).
- Details of Bank
Account in the prescribed format for easy/quick transfer of funds through
Electronic Clearing System, duly verified by your Bank (Annexure II).
- Verification
Certificate for number of animals sheltered in the shelter as on date to
be verified by Board/Co-opted Member, AWBI/ a Government Veterinary
Officer of Animal Husbandry Department of the concerned District on the
Govt. letterhead duly signed and sealed with his name, address, telephone
numbers. Details of sheltered animals as per Sl.No.7 (e). (Annexure
III).
- Verification
Certificate for number of animals rescued, treated in the
dispensary/mobile clinic/camps and cruelty cases booked/legal cases filed
if any, during the previous year to be verified by a competent Veterinary
Officer of Animal Husbandry Department on the Govt. letterhead duly signed
and sealed with his name, address, telephone numbers (Annexure III).
- A verification
certificate regarding address and activity of the organization by Local
Body i.e. Panchayat/Village/Municipality/Corporation or Revenue Department
on the Govt. letterhead duly signed and sealed with his name, address,
telephone numbers
(Annexure IV). - Details of Fixed
Deposits, source of other income like grants from State Government, other
Govt. Departments, or agencies, donations, foreign donations through FCRA,
rent on buildings, sale of products etc.
- If the organization is producing any products from cow
dung and urine, then a complete detailed report may be given.
- Utilization Certificate and Statement of Accounts of
grant released to your organization duly signed by Chartered Accountant
with Membership Number and Seal, if any pending.
- Audited Accounts and Balance Sheet, Activity report,
Annual Report of the organization along with press clippings if any for
the last three years, if not sent earlier.
- Details of Veterinary
Doctors with Veterinary Council of India Registration Number, Inspectors,
Veterinary Assistants, Compounders, Ambulance Drivers etc. available with
the Organization.
ANNEXURE I
(To be executed on Rs.10/- Non-Judicial Stamp Paper
by the Organization)
U N D E R T A K I N G
With reference
to our application for grant-in-aid submitted to the Animal Welfare Board of
India, Chennai, we hereby give the following undertaking for consideration of
grant-in-aid to our organization.
1.
We,
(Name & address of Organization) _____________________________________
______________________________________________________ (AWBI Code No. _________
) will not dispose off male calves by sale/auction etc. and castrate them if
not used for breeding purposes.
2.
We
will keep a record of all male calves and if the male calves are given to the
farmers for use in agricultural operations, then an undertaking will be taken
from the farmers that they will not sell the calves to anybody.
3.
We
hereby give our undertaking to the effect that our organization has never been
involved in any corrupt practice of any nature.
Signature of Secretary Signature
of President
(Name, Telephone Nos. &
address in capital letters with office seal)
Place:
Date:
ANNEXURE II
(To
be obtained on the letterhead of Bank)
To
The Secretary
Animal Welfare Board of
India
Chennai – 600 041
We hereby
certify the following details for transfer of funds through Electronic Clearing
System to the following organization who is having account with our Bank.
1. Name of the Organization :
2. Address of the
Organization :
3. Name of the Bank, Branch
& Address :
4. Account No. of the
Organization :
5. IFSC Code Number of the
Bank :
6. Name, address & designation
of signatories of the Organization. :
Name & Signature of the
Manager of Bank
ANNEXURE III
(To
be obtained on the letterhead of the Board/Co-opted
Member, AWBI/
a Government Veterinary Officer of Animal Husbandry
Department
of the concerned District)
To
The Secretary
Animal Welfare Board of
India
Chennai – 600 041
This is to
certify that the following organization is maintaining animals in their shelter
as per the details given below:
1. Name & address of
the Organization :
2.Address of Shelter House :
3. Number and details of
Shelters available :
4. Number of animals
sheltered in the shelter house by the Organization as on ________________
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
|
Cows |
Buffal oes |
Milching animals |
Ox/ Bullo Cks |
Male Calves |
Female Calves |
Hors es |
Donk eys |
Sheep/ Goat |
Cats/ Kittens |
Dogs/ Pupp ies |
Other animals (specify category) |
Total |
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Details of other animals
(Column No. 12) :
5. Number of animals
rescued during the year 200__- 200__ (1.4.200__ to 31.3.200__) :
6. Number of animals
treated by the organization during the year 200__- 200__
(1.4.200__ to 31.3.200__) :
(As verified from animal treatment register maintained by the
organization)
a) In their
in-house dispensary/hospital :
b) Sick and
injured animals on the spot :
c) In medical
camps :
d) By Mobile Clinics :
Total :
7. Number of cruelty cases
booked by the organization :
8. Number of Legal cases
filed by the organization :
Signature & Office Seal
Name of the Officer
Designation
Department
Telephone Nos.
Place:
Date of Verification:
ANNEXURE IV
(
To be obtained on the letterhead of the Local body
i.e.
Panchayat/Village/Municipality/Corporation or Revenue Dept.)
To
The Secretary
Animal Welfare Board of
India
Chennai – 600 041
This is to
certify that the following organization is working and the details are as
under:
1. Name of the Organization :
2. Address of the
Organization (Office) :
Address of Shelter/Gaushala/Site :