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 relief for animals during Natural Calamities and unforeseen circumstances

 

 

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/Govening Body

 

 

 

 

6.       A copy of the Annual cum Progress Report        :

          and Audited Annual Accounts for the

          previous year (s) which should contain the

          Balance Sheet, Income & Expenditure A/c.

          and Receipt and Payment A/c.

 

7.       Budget Estimates to be furnished as                   :

          per Annexure IV

 

8.       Details of Beneficiaries/facilities available with    :

          the Organisation as per Annexure - I

 

9.       Details of Staff Employed as per                         :

          Annexure II

 

10.     List of Documents to be attached as per             :

          Annexure - III

 

11.     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, specially in case of new organisation, 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                                             :

Details 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

 

Name of the Scheme                        :

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 document required to be submitted for the Scheme for Relief to Animals during natural calamities and unforeseen circumstances

(i)      Application in prescribed proforma

(ii)      The detailed proposal and its justification alongwith gist of existing activities undertaken and   assets acquired.

(iii)     Photocopy of Registration

(iv)     Memorandum of Association

(v)     Budget Estimate

(vi)     Gazette Notification about declaration of natural calamities

(vii)    List of Governing Body

(viii)   Latest Audited Accounts available in four parts duly certified by a Chartered Accountant as    follows:

          a.  Audit Report

          b.  Balance Sheet

          c.  Receipt & Payment A/C

          d.  Income & Expenditure A/C

 

 

Annexure IV

List of items of expenditure for which assistance could be provided under the Scheme of Relief to Animals during Natural Calamities and Unforeseen Circumstances

1.       Emergency feeds

2.       Repair of shelters/sheds

3.       Requirement of water tanks/well digging etc.

4.       Repair of the drainage system

5.       Provision of medicines and medical equipments

6.       Fees for veterinary doctors/compounders and other relief experts

7.       Cleanliness operations

8.       Provision for trapping and tranquiliser guns

9.       Expenditure on electricity and other such amenities required on provisional basis to provide relief to animals

10.     Any other item of expenditure deemed fit by the competent authority.

 

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