ADIP Scheme

Annexure–I

Application for Central Scheme of Assistance to Disabled Persons for Purchase/Fitting of Aids/Appliances

From Date:

TO,

The Secretary to the Government of India,
Ministry of Social Justice & Empowerment,
Shastri Bhawan,
New Delhi – 110 001

Subject: Assistance under the Central Scheme of Assistance to Disabled Personas for purchase/fitting of aids/appliances.

I submit herewith an application for a grant for the year under the Scheme of Assistance to disabled persons for purchase/fitting of aids/appliances. I certify that I have read the rules and regulations of the Scheme and I undertake to abide by them, on behalf of the Management. I further agree to the following conditions :

All assets acquired wholly or substantially out of the Central grant shall not be encumbered or disposed off or utilised for purpose other than those for which the grant is given. Should the Institution/Organisation cease to exist at any time, such properties shall revert to the Government of India.

The accounts of the project shall be properly and separately maintained. They shall always be open to check by an officer deputed by the Govt. of India or the State Government. They shall also be open to test check by the Comptroller and Auditor General of India at his discretion.

If the State or the Central Govt. has reasons to believe that the grant is not being utilised for approved purposes, the Govt. of India may stop payment of further Instalments and recovers earlier grants in such a manner as they may decide.

The Institution shall exercise reasonable economy in the implementation of the scheme.

The Organisation will obtain an undertaking from the beneficiaries as required under the scheme, before fitting/giving of aids/appliances.

Yours faithfully

(Signature)

(Designation)

(Office Stamp)

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ANNEXURE-II

Ministry of Social Justice & Empowerment

Name of the Scheme:

Application form for New Proposal

Organisation
Name:
Address(Office):
(Project):
Phone (Office):
(Project):
Fax (Office):
(Project):
Telex (Office):
(Project):
E-mail (Office):
(Project):
Grams (Office):
(Project):

1. Name of the Act:
   under which registered
2. Registration No. and date:
   of Registration (Please Attach a photocopy)

Any other Organisation/Institute/:
Body, if applicable, give details

Registration under Foreign: (Yes/No) Contribution Act

Memorandum of Association and:
Bye-Laws.
(please attach a photocopy)

Name & address of the Members of:
of the Board of Management/
Governing body

List of Documents to be attached.

A copy of the Annual Report for the previous year which should contain the balance sheet (including receipt and payment account), income and Expenditure Account.

Details of the project for which the grant-in aid is being applied.

Grant-in-aid applied for in the current year.

Details of beneficiaries

1. Number of disabled benefited From previous year's grant.
2. Proposed number of disabled expected to be covered during current financial year.

Details of the staff available

List of Additional papers (if any given)

I have read the scheme and fulfil the requirement and conditions of the scheme. I undertake to abide by all the conditions of the Scheme

Signature …………………………

Name …………………………

Address …………………………
…………………………

Date …………………………

(seal)

Note: Wherever not applicable, specially in case of new Organisation, Please write – N.A...