PROFORMA FOR APPLICATION OF VOLUNTARY ORGANISATION FOR NEW PROJECT

PROPOSALS FOR RECEIVING GRANT-IN-AID FROM THE MINISTRY OF SOCIAL JUSTICE &
EMPOWERMENT UNDER THE SCHEME OF PREVENTION OF ALCOHOLISM AND SUBSTANCE
(DRUGS) ABUSE (For New Cases) Form
Name of Scheme: Prevention of Alcoholism and Substance (Drug) Abuse
Nature of Project: Integrated Rehabilititation Centre for Addicts(IRCA)
State: MAHARASHTRA District: RAIGAD

Application 03/02/2020 Financial 2019-20

Organization Details

NGO Id: MH/00005312 City: SANGLI

Name of NGO: atpadi taluka gramin vikas sanstha atpadi Address: At Post Kargani Taluka Atpadi Dist Sangli
Pincode 415306

State: MAHARASHTRA District: SANGLI

Email: ujpatil@gmail.com Phone: 9767574393

Key Functionaries of the organisation

Name Educational Address Contact Email Designation Achievements

Umesh Patil M.Pharm kargani, 9767574393 ujpatil@gmail.com President implementation of

maharashtra rehabilitation
program

Birrappa Shejal M.E. solapur, 9359800361 ssuryakumar@redi tresurer INVOLVED IN

mahrashtra ffmail.com SR. CITIZEN
CARE IN
NASHIK
DISTRICT

Act Name: Charity Commissioner

Registration Number: MH/SANGLI/F-9844/2004

Registration Date: 12/01/2004

Registration Valid upto: 31/12/2050

Whether activities relating to alcoholism and drug prevention included in the MOA of the organization: Yes

Project not related to alcoholism and drug abuse prevention

Nature of work done Period of work done Coverage of Achievement and Source of funding
Beneficiaries Award
From To

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Name of NGO: atpadi taluka gramin vikas sanstha atpadi

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 SR.CITIZEN HOME 01/01/2017 31/12/2020 150 EXCELLENCE IN DONATION
OLD AGE CARE

Project related with alcoholism and drug abuse prevention

Nature of work done Period of work done Coverage of Achievement and Source of funding
Beneficiaries Award
From To

Aaradhy'a 01/01/2017 31/12/2020 4700 EXCELLENCE IN central government

rehabilitation center REHABILITATION
Kamarli

Justification for setting up of the project in the District, Service Details

Nature and Incidence of alcohol /drugs yes

abuse in the area as provided in any
established study/survey(comments):

Document Uploaded: No

Name and Address of available service in the district (such as existing IRCA/Govt. Hospital), Service Details:

no any available

If service already available in the no any available

district , provide justification for setting
up of the new project:

Approximate distance of the proposed project from the available services: 195.0

If similar service is not available in the district

Distance from the nearest organization/institution/scheme/project: 195.0

Name and Location address of such IRCA Pune
nearest organization/institution:

Any other justification: required for better life

Name of Project, If any: Aaradhys Rehabilitation Centre for Addicts Kamrali

Project Location

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Name of NGO: atpadi taluka gramin vikas sanstha atpadi

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Address: kamarali Landmark: kamrli bus stand

E-Mail: ujpatil@gmail.com Phone: 8149453953

City/Town/Village: kamrali Fax:

Location Type: Rural Pincode: 402107

Name of project in-charge: Navaj Jamadar

E-Mail of project in-charge: njamadar@yahoo.com

Contact details of project in-charge: 9673400049

Is the project already functional : Yes

Date of commencement of the Project, if project already functional: 01/01/2017

Infrastructure Details

Building where project is proposed: Rented

Rent Agreement, If Building is rented

Name of Owner: rajesh patil

Name of the Tenant: umesh jayantrao patil

Rent for Month(in Rs.): 15000.0

Mobile no of Owner: 9403137540

(STD Code)Tel. No:

Aadhar no of Owner: ********9993

Bank Account no. of owner: 20203127420

IFSC code of the Bank: MAHB0001010

Address of owner: kamrali maharashtra

City / Town / Village: kamrali

Landmark: bus stand

PIN Code: 402107

Whether adequate space and required facilities such as toilets/bathrooms/ water supply/electricity Yes

If No Provide details of usages:

Specify the accommodation and facilities available for the project

Total Covered Area (In sq. meters): 1500.0 No. of Rooms: 3

No. of Veranda: 2 No. of Toilets/Bathrooms: 4

Kitchen facilities exists: Yes Whether open area available: Yes

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Name of NGO: atpadi taluka gramin vikas sanstha atpadi

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Whether recreational facilities available: Yes

Details of two key staffs that will be or likely to be associated with the project

Name Designation Educational No. of Areas of Whether educational Outstanding

Qualification years Experience qualification & achievements
Experienc experience verified from
e record
NAVAJ ASLAM SUPERITENDE PhD 10 REHABILITAT YES rehabilition
JAMADAR NT ION
UMAJI MAHADEV YOGA MA.BED 7 REHABILITAT YES DRUGS
CHAVAN THERAPIST ION

Whether beneficiaries identified so far: Yes

The amount of support sought from the Ministry for recurring grants-in-aid

Non-recurring: 375000.0 Recurring: 4504800.0 Total Amount: 4879800.0

Verification
Certified that above information is in accordance with the records and accounts audited/ to be audited and is correct to the
best of knowledge and belief of the office-bearers of the organization, and after its perusal and satisfaction, they have
authorized the undersigned by a resolution dated 02/02/2020 to verify and submit the statement of information for purposes
of monitoring the scheme for which grants-in-aid was received from the Ministry of Social Justice & empowerment, Govt. of
India.
2. I also hereby 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 condition :-
a. All moneys given as Grant in Aid and all assets acquired wholly or substantially out of the central grant shall not be
encumbered or disposed of or utilised for purposes other than those for which the grant is given. Should the organisation
cease to exist or violate the above condition at any time, such properties shall revert to the Government of India.

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

c. If the State or the Central Government have reasons to believe that the grant is not being utilised for approved purposes;
the Government of India may stop payment of further installments and recover earlier grant in such manner as they may
decide.

d. The institution shall exercise reasonable economy in its working and particularly in respect of expenditure on building.

e. Progress reports on the project will be furnished at regular intervals as may be specified by the Government.

f. The organisation will bear 10% of the estimated expenditure or the balance of the estimated expenditure on the project as
per the guidelines
g. The organisation agrees to make reservation for the Scheduled Castes/Schedule Tribe candidate/Disabled persons for
appointment against the posts required for the working of the organisation in accordance with instructions issued by the
Government of India from time to time.
h. It is hereby certified that no grant is being applied/ received for the same project from any other (Central/State
Government/ foreign) source.
i. The organization agrees to open separate current bank account for the project for receiving grant from the Ministry.

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Name of NGO: atpadi taluka gramin vikas sanstha atpadi

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j. The organization agrees to comply with the guidelines issued by the Finance Ministry from time to time. (Such as
Implementation of EAT module of PFMS etc).

Yours Faithfully

Name of Authorised Person: umesh jayantrao patil

Contact Number: 9767574393

Date: 03/02/2020

Time: 8:22 AM

Place: raigad

Documents

Document Name Uploaded

Certified copy of the Registration Certificate under Societies Registration Act,1860 or Charitable Trust Act Yes
etc.

Memorandum of Association and copies of rules, aims and objectives of the organization Yes

List of Management/Managing Committee Members Yes

List of beneficiaries for previous year Yes

Rent agreement in respect of de-addition centre, if anywith address and signature of witness and attestd by Yes
notary(In case of centre located in rural area, The rural area certicate from competant Athority may be
enclosed)
Annual Report for last three years Yes

Audited Accounts comprising Balance Sheet, Income & Expenditure Statement and Receipt & Payment Yes
account for last three years

Budget Estimate (item wise recurring & non-recurring Expenditure) Yes

Bank Authorisation letter Yes

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Name of NGO: atpadi taluka gramin vikas sanstha atpadi

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