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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
E-mail Loksevasharam_hil@yahoo.co.in
website

4. Name of contact person(s):-

LAST NAME MIDDLE NAME FIRST NAME


4.1 NAME PRASAD LAKHAN RADHEY
DESIGNATION SECRETARY GENERAL
4.2 NAME AHAMED BAHAR Md.
DESIGNATION TREASURER
5. Details of registration (Kindly Enclose copy of relevant certificate (s))

(Please put  against applicable Act) 950/2002-03

State : BIHAR
District : NALANDA
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 ) Date of Original Registration (27.11.1992)

Registration valid up to : ( PERMANENT )

5.2 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) Registration valid up to ( PERMANENT )

6. 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 Lok Sabha Member(MP) : SHRI RAM SWAROOP PRASAD
7.2 Vidhan Sabha member (MLA) : SHRI RAM CHARITRA PD. SINGH
7.3 Village Sarpanch/gram Pradhan : URMILA DEVI
7.4 The Collector & District Magistrate : ANAND KISHORE
7.5 Project Director, District Rural : PRAMOD KUMAR
Development Agency
7.6 Block Development Officer : 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 __________

Name of CAPART official : _________ NO __________

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 Schemes taken up (CAPART or Others) in past 3 years?

Sr. Title of S4cheme Amount Completed/ongoi Measures


No. Rupees ng taken for
sustainability
1. CONDENG COURSE OF 1,11,250/- COMPLETED ATTACHED U.C
EDUCATION MIDDLE-I
2. CONDENSE COURSE 1,23,500/- ON GOING
OF EDUCATION ,
BATCH-II MATRIC
3. CRECHE PROGRAMME 1,35,820/- ON GOING
FOR CHILDREN
BELOW 6 YRS
4. TOTAL SANITATION ON GOING
COMPAIGN

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)  REMOTE/ DIFFICULT AREA


(R)
HILLY (H) FLOOD PRONE (F)  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 Period of time


as per Table-1 speniworking in
the area
BIHAR NALANDA AW01, AW02, DW01, 15 YEARS
DW03
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 Children


(A) A (M) M (C)
Bonded Labor SC Women
(B) (S) S (W) W

Landless Labor Artisans R Disabled


(L) L (R) (P) P

Any Other (Specify) O OTHER VOs Tribal

(O) (v) (T)

12. 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 Geophysicist Lawyers
Nutritionists Economists Geologists
Health Staff 01 Social Workers 06 Veterinarians

Dais 01 Social Animators 03 Foresters


Audio-visual Experts Chartered Accountants 01 Architects
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 File Title of Locatio Particulars of Sanctions Sanctioned No. of Units Release Made Date of Remarks
n No proposal n And Beneficiaries units Completion
o (give) /
State
District
Submission
Block Of UC*
Village
(s)

D CAPART Others Total Units SC/ST OBC Others D Amount


ate Assistant (Rs.) (Rs.) (Rs) (Rs.) ate

1 2 3 4 5b 5c 5d 6a 6b 6c 6d 7b 8 9
5a 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.)
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 Income Expenditure
(Rupees in Lack) (Rupees in Lack)
1) 2004-2005 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. RECEIPT & PAYMENT:

Sr. No Year Receipt Payment


(Rupees in Lack) (Rupees in lack)
1) 2004-2005 5,02,531/- 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.
Receipts Items Year Details Year Year
No 2004-2005 2005-2006 2006-07
1) Name ofAmount
the Bank % MADHYA BIHAR
Amount MADHYAAmount
% BIHAR %
(Rupees) GRAMIN BANK
(Rupees) GRAMIN BANK
(Rupees)
2) Full Branch Address HILSA CHIKSAURA
Total funds Account 4,08,405
Number
100 % 5,59,517/ 100 % 5,75,053/ 100 %
3) 7562 1095
Received /- - -
4) Type Of Account
From Government 61,530/- SAVING SAVING
15.06 % 1,18,280/ 21.13 % 20,135/- 3.5 %
5) Name of Signatory (1) RADHEY
- LAKHAN PRASAD
From Foreign Post Held
-----in ----- -----
GEN. SECRETARY---- ----- -----
Source organization
Own Source Relationship
40,800/-to chief
9.99 % 42,300/- 7.56 % 41,630/- 7.23 %
functionary
6)
By Community Name of Signatory(2)
3,06,075 Md.3,98,937/
74.94 % BAHAR AHAMED
71.03 % 5,13,288/ 89.25 %
ContributionsPost held
/- in -
TREASURER -
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) Salary/emolument 21,000/- 50 %
s
2) Facilities for Staff 3,518/- 8.38 %
3) Fuel, oil, ----- ----
lubricants
4) Travel 4,786/- 11.40 %

5) Telephone --------- ----


6) Office 8,244/- 19 %
expenses(Rent)
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: Authorized Signatory

Designation: Name:
Designation:

Place: SEAL OF THE ORGANIZATION

Date:
FOR CAPART USE ONLY
Computer Generated Number allotted:-

Date Signature

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