2 July

ORGANISATION PROFILE OF APPLICATION FOR

CAPART A SS IS TANCE

(OTHER THAN FIRST TIMER) (PLEASE FILL IN BLOCK/ CAPITAL LETTERS)

PART-A : ORGANISATIONAL DETAILS

Name of the Organisation

LOK SEVASHRAM CHIKSAURA

Registered Address

AR+P.O: CHIKSAURA (DALLOO BIGHA)

Block

HILSA

Police Station

HILSA

District

NALANDA

State

BIHAR

Pin Code

801302

1. 2.1

2.2 Details of Branch Office (S) if any.( Append details of Branch Offices on additional sheets, if required.) Address

SHANTI NAGAR, SAIDANPORE MORE , HILSA

Block

HILSA

Police Station

HILSA

District

NALANDA

State

BIHAR

Pin Code

801302

3.

Contact Numbers Phone No (1)

06111-253556

Phone No (2)

9934843826

Mobile Number Telegram Fax [email protected]

E-mail website

4. Name of contact person(s):-

4.1

4.2

LAST NAME

MIDDLE NAME

FIRST NAME

NAME

PRASAD

LAKHAN

RADHEY

DESIGNATION

SECRETARY

GENERAL

NAME

AHAMED

BAHAR

DESIGNATION

TREASURER

Md.

5. Details of registration (Kindly Enclose copy of relevant certificate (s)) (Please put  against applicable Act) State

:

BIHAR

District

:

NALANDA

950/2002-03

Societies Registration Act, 1860 : ……………………….……………………………………… Indian Trusts, Act,1882

:………………… .....………………………………………...

The religious and charitable institutions Registration Act, 1920………..………………… If Registered under other Act, Please specify.

5.1

Registration No

( 600 )

Registration valid up to :

5.2

Date of Original Registration (27.11.1992) ( PERMANENT )

Detail of Foreign Contribution Regulation Act,1976 ( ) (if applicable, kindly enclose copy of certificate)

Date of original Registration : (10.05.2005) Original Registration No (031340099) 6.

Registration valid up to ( PERMANENT )

Are there any criminal cases pending against the Organization or office bearers NO (Yes/No)

7.

Detail of people’s representative of the target area (Full name and address to be provided)

7.1 7.2 7.3 7.4 7.5 7.6

Lok Sabha Member(MP) Vidhan Sabha member (MLA) Village Sarpanch/gram Pradhan The Collector & District Magistrate Project Director, District Rural Development Agency Block Development Officer

: : : : :

SHRI RAM SWAROOP PRASAD SHRI RAM CHARITRA PD. SINGH URMILA DEVI ANAND KISHORE PRAMOD KUMAR

:

ANWAR AHMED

8-2 DETAILS OF FUNCTIONARIES (The item is to be filled for each) Name Designation

MEMBER

8.2.2.

state whether office held, ion any other VO (s) : Yes/No: NO

8.2.3.

Details of the offices held other VO(s)

8.2.4.

(in case answer to 8-2-2, is Yes)

Name of the Organisation

: _________

NO

__________

Address of the Organisation : __________

NO

___________

Name of the Organisation

: _________

NO

__________

Address of the Organisation : _________

NO

___________

Name of the Organisation

: _________

NO

__________

Address of the Organisation : _________

NO

___________

8-2-4 DETAILS OF RELATIONSHIP WITH CAPART OFFICIALS, IF APPLICABLE. Name of CAPART official

: _________

NO

__________

Designation

: _________

NO

__________

Official address

: _________

NO

__________

Name of CAPART official

: _________

NO

__________

Designation

: _________

NO

__________

Official address

: _________

NO

__________

NO

__________

Name of CAPART official

: _________

Designation

: _________

NO

__________

Official address

: _________

NO

__________

8.2.5 Are there any members of the family of the chief. Who receive salary/honorarium from the Organisation? If yes, give details. 8.2.6 Please submit details of personal assets of chief functionary. 8.2.7 Is the chief functionary the founder of the Organisation? If not how years has he been working in rural area ?(Kindly attach his bio-data) Part-B : Details of Activities 9.

Activities (please refer to Table:9-1 on Activities codes and give

appropriate codes for Multiple activities, give more than one code as demand fit) AW01, AW02, DW01, DW03

9.1.1 Sr. No. 1. 2. 3. 4.

Schemes taken up (CAPART or Others) in past 3 years? Title of S4cheme CONDENG COURSE OF EDUCATION MIDDLE-I CONDENSE COURSE OF EDUCATION , BATCH-II MATRIC CRECHE PROGRAMME FOR CHILDREN BELOW 6 YRS TOTAL SANITATION COMPAIGN

Amount Rupees

Completed/ongoi ng

1,11,250/-

COMPLETED

1,23,500/-

ON GOING

1,35,820/-

ON GOING

Measures taken for sustainability ATTACHED U.C

ON GOING

9.2

Have you undertaken project involving people’s participation? If yes , state it in 50 word on separate sheet. (YES, ATTACHED ANNEXURE I)

9.3

Have you undertaken projects for organizing and mobilizing the poor, SC/ST, disabled or women ? if yes, state it in a separate sheet in100 words. Attached separate sheet. (YES)

10

Geographical area of operation Please tick () appropriate code from the list below):(ATTACHED ANNEXURE II )

COASTAL (C)

EARTHQUAKE PRONE (E) 

TRIBAL (T)

DESERT (D)

DROUGHT PRONE (P)

HILLY (H)

FLOOD PRONE (F)

REMOTE/ DIFFICULT AREA (R) ANY OTHER (SPECIFY) (O)

10.1

 

Total number of different Districts in which activities have been undertaken 02

10.2

District wise Details:-

State

District

Major Activities codes as per Table-1

BIHAR

NALANDA

AW01, AW02, DW01, DW03

Period of time speniworking in the area 15 YEARS

10.3 is the project for which funding is being taken up I the new area? Yes/no ()

10.4 if yes, then how long do you in word in this area?

N.A

11. MAIN TARGET GROUP (PLEASE GIVE APPROPRIATE CODE FROM LIST BELOW) Agricultural Laborers

Small and marginal farmers

A

(A)

(M)

M

Children (C)

Bonded Labor

SC

(B)

(S)

S

(W)

Landless Labor

Artisans

R

Disabled

(L) Any Other (Specify) (O) 12.

Women

L

(R)

(P)

O

OTHER VOs

Tribal

(v)

(T)

W

P

PROFESSIONAL STAFF PRESENTLY WORKING IN THE ORGANIZATION (PLEAS GIVE THE NUMBER OF STAFF AGAINST APPROPRIATE ITEM. (Also specify whether full time or part time)

Doctors

Engineers

Teachers

08

Homeopaths

Technologists

Trainers

02

Ayurveds Nutritionists

Geophysicist Economists

Lawyers Geologists

Health Staff

01

Social Workers

06

Veterinarians

Dais

01

Social Animators

03

Foresters

Chartered Accountants 01

Architects

Audio-visual Experts Eperts

01

Accountants

01

Others (pleas specify)3

12.1 NO. OF STAFF PRESENTLY WORKING IN THE ORGANIZATION ON:Full time

15

Part time

03

Voluntary

08

Total

26

Are any existing paid staff rotated to effect of Executive body managing committee of the voluntary Organization? If yes, give detail. 13

DETAILS OF CAPART ASSISTED PROJECTS ALREADY UNDERTAKEN BY THE VO (In Chronological order by the date of sanction)

Si n o

File No

Title of proposal

Locatio n (give)

Particulars of Sanctions

Sanctioned No. of Units And Beneficiaries units

Release Made

Date of Completion /

Remarks

State District Submission Of UC*

Block Village (s) D ate 1

2

3

4

CAPART Assistant

Others

Total

Units (Rs.)

SC/ST (Rs.)

OBC (Rs)

Others (Rs.)

5b

5c

5d

6a

6b

6c

6d

5a

D ate

Amount 7b

8

7a

N.A

•

Kindly attach photocopies of UC of completed projects.

PART-C: FINANCIAL STATUS OF ORGANISATION Kindly provide:-a) Copies of Annual Reports of Last three years

(ATT.)

b) Copies of Audited Statement of accounts of last three years (ATT.)

9

c) Copies of proof of having post office/Bank Account of last three years

(ATT. )

d) Copies of permanent Account Number issued by Income Tax department (ATT.) 14. INCOME AND EXPENDITURE:Sr. No Year (Rupees in Lack) 1) 2004-2005

Income (Rupees in Lack) 5,01,488/-

5,01,488/-

2)

2005-2006

7,66,268/-

7,66,268/-

3)

2006-2007

9,22,923/-

9,22,923/-

15.

Expenditure

RECEIPT & PAYMENT:

Sr. No 1)

Year (Rupees in Lack) 2004-2005

Receipt (Rupees in lack) 5,02,531/-

Payment 5,02,531/-

2)

2005-2006

7,86,321/-

7,86,321/-

3)

2006-2007

10,00,811/-

10,00,811/-

16. MAJOR ASSETS OF ORGANIZATION AS PER LAST AUDITED BALANCE SHEET (This includes Land, Building with plinth area etc.) Sr. No

Assets

Value (Rupees in Lacs)

1)

Cash Deposits

77,321=00

2)

Movable assets

2,03,416=70

3)

Immovable Assets

1,12,000=00

(Please Attach list of all movable and immovable assets of value over Rs. 20,000/-) ATT. 17. DETAILS OF BANK ACCOUNT FROM WHICH CAPART FUNDS HAVE BEEN/ PROPOSED TO BE OPERATED.

17.1 Account in the Name of “ LOK SEVASHARAM CHIKSAURA” (Attach photocopy of pass book) 17.2 Details of Bank Accounts:Sr. Items Details Receipts Year Year Year No 2004-2005 2005-2006 2006-07 Name ofAmount the Bank 1) BIHAR MADHYAAmount BIHAR % MADHYA Amount % % GRAMIN BANK GRAMIN BANK (Rupees) (Rupees) (Rupees) Full Branch Address 2) HILSA CHIKSAURA Total funds Account 4,08,405 100 % 5,59,517/ 100 % 5,75,053/ 100 % Number 3) 7562 1095 Received /Type Of Account 4) SAVING SAVING From Government 61,530/15.06 % 1,18,280/ 21.13 % 20,135/3.5 % Name of Signatory (1) 5) RADHEY LAKHAN PRASAD From Foreign Post Held -----in -------------------GEN. SECRETARY Source organization to chief Own Source Relationship 40,800/9.99 % 42,300/7.56 % 41,630/7.23 % functionary

Name of Signatory(2) 6) Md.3,98,937/ BAHAR AHAMED By Community 3,06,075 74.94 % 71.03 % ContributionsPost held /- in TREASURER

5,13,288/ -

89.25 %

organization

17.3 SUMMARY OF RECEIPTS Give details from the Audited statements of accounts for the last 3 years as indicated below:17.3.1 BREAK

UP OF

RECEIPTS. (Receipt & Payment)

17.3.2 What percentage of total expenditure was spent on administration last year? 17.3.3 Break up of Administration expenditure in percentage: Clarification on page. Sr. Administrative Amount (in Rupees) Percentage No Expenditure 1) 2) 3) 4) 5) 6)

Salary/emolument s Facilities for Staff Fuel, oil, lubricants Travel

21,000/-

50

%

3,518/-----

8.38 % ----

4,786/-

11.40 %

Telephone Office expenses(Rent)

--------8,244/-

---19 %

7)

Any Other

4,418/-

10 %

Total

41,966/-

100 %

17.3.4 Has your organization been black listed/put understanding restrictions by CAPART/ Any Other organization? ( NO) If Yes, Give details. 18. Are Annual Reports and Audited statement freely available to any member of The public? Yes/No (YES). If no, the reasons thereof __________________

19. Certified that the information given in this form is correct to the best of our knowledge. It is understand that tendering false information will result in CAPART recalling the assistance and stopping further funding of the VO. Counter signed by Member of the Executive body

Name:

Designation:

Authorized Signatory

Name: Designation:

Place: Date:

SEAL OF THE ORGANIZATION

FOR CAPART USE ONLY Computer Generated Number allotted:-

Date

Signature