Annexure-D

Mamata Scheme AWC Monthly Report

(To be collected by the Supervisor and submitted to the CDPO)
Reporting Month : Year:
AWC: No of new beneficiaries registered this month:
Sector: No of beneficiaries sponsored for 1st instalment this month:
Project: No of beneficiaries sponsored for 2nd instalment this month:
District: No of beneficiaries exiting without instalment this month:

New Registrations
Annexure-B New Photocopy of the
Photocopy of the Photocopy of the Entry Done in Web
ICDS Register-5 : (Undertaking by first page of MCP
first page of Aadhaar / UID Card Based MIS (For
Srl No Name of Beneficiary Pregnancy and Beneficiary) Card with MCT/RCH
passbook attached attached CDPO Office use) --
Delivery Details attached No attached
(Yes / No) (Yes / No) Initial of PA
(Yes / No) (Yes / No)

First Instalment
Photocopy of filled- Entry Done in Web
in Based MIS (For
Srl No Name of Beneficiary Aadhaar No MCT No Amount Due Reason for exit
Annexure-C CDPO Office use) --
attached Initial of PA

4
(Reasons for exit: 1-Miscarriage)
Second Instalment
Photocopy of filled- Entry Done in Web
in Based MIS (For
Srl No Name of Beneficiary Aadhaar No MCT No Amount Due Reason for exit
Annexure-C CDPO Office use) --
attached Initial of PA

4
(Reason for exit: 5-Received all due installments)
Exit without instalment
Entry Done in Web
Photocopy of
Based MIS (For
Srl No Name of Beneficiary Aadhaar No MCT No Annexure-C Reason for exit
CDPO Office use) --
attached
Initial of PA

4
(Reasons for exit: 1-Miscarriaage, 2-Maternal Death, 3-Still Birth, 4-Infant Death, 6-Migration)

Declaration :
I certify that the above beneficiaries have fulfilled necessary conditions to get their respective instalment as per the scheme guidelines.
The copy of filled in Annexure-C is attached. I also agree that there is no misrepresentation of information on my part.

Reported by: Collected by: Data Entry by (For CDPO Office use):
AWW: Supervisor: PA
Signature: Signature: Signature
Date: Date: Date: