Application formate for the Grant

Sr.no Subject Particulars

1. Name of Agency RAJ SOCIAL WELFARE SOCIETY ,
AMROHA UTTAR PRADESH
2. Legel status Registered under society act of 1860
686/2009
3. Date of registration/ incorporation 16/07/2009
4. Contect no. & E-mail address Mo -9917356691.
Email –rsws65594@gmail.com
5. Postal address Vill – Malikheda ,Post – Amroha Dist-
Amroha ( Uttar Pradesh) 244221
6. Bank account No. and IFSC code of Branch with Bank Name : SBI AMROHA
address Account no: 33899996411
IFSC code : SBIN0016760
Address : Joya road Amroha
7. Name , address and Aadhar Number of Mr . Riyazuddin ,
President/ Secretary / Trustee of the agency Add: Vill- Malikheda Post Amroha ,
Dist Amroha (U.P.)244221
Aadhar No. -610759053256
8. In case of NGO furnish-
i. Date of registration on DARPAN Year: 2015
Portal
ii. Unique ID generated on DARPAN Unique ID: UP/2015/0086490
Portal
9. Brief on the activities conducted by the agency Atached in ANAXURE -1
in past three years( attach additional sheets . if
necessary)
10. Colibration partner’s name and proof ( reputed Atached in ANAXURE -2
university /institute /government department)
11. Whatever Road safety awareness or any related NA
programmes have been eailer conduted by the
agency , if yes give detail thereof ( attach
additional sheets if necessary ) submit proof of
effectiveness of those programs
12. Brief of the proposal activity proposed to be Atached in ANAXURE-4
undertaken indicated the target group , place
content of programme and the proposed time
period for conducting the programme ( attach
additional sheets )
13. Total estimated cost of Proposal ( attach a copy 5,35,000.00( BUDGET INCLOSED)
of estimate ) ANAXURE -5
14. Target set :

S.no. Activities Start Date Complete date Target Proposed Grant Amount
1. Mobilizatioin
2. Milestone -1
3. Milestone -2
4. Milestone -3