Documents & Declaration for Indicator 1.

5
Data required for Q3:

Whether the ULB/State/UT has banned (notified) the Yes  No 

use/sale and storage of non-biodegradable plastic
bags/plastic products less than 75 microns in compliance If YES, Notification is released by
with Plastic Waste Management Rules 2021?
State  ULB  UT 

November: ______________
If ban is enforced, Number of challans/penalty (counts) levied December: ______________
by the ULB for non-compliance with the notification: January: ________________
Total No. of challans in Qtr 3: __________

November: Rs. ______________

If ban is enforced, Amount collected by the ULB for non- December: Rs. ______________
compliance with the plastic ban notification: January: Rs. ________________
Total Amt collected in Qtr. 3: Rs. ___________

Documents to be submitted by the ULB for evaluation:

Scanned copy of the notification by the ULB/State/UT banning

the use/sale and storage of plastic bags/plastic products less Attached  Not Available. 
than 75 microns

Scanned copies(or digital receipts) of at least 5% of challans Attached  Not Available. 

I hereby declare that the data/information provided above table, on Swachhatam portal and in the attached
documents is true to the best of my knowledge and reflects the status of the progress on ground in the ULB.

Signature & Stamp of the Nodal Officer/Head of the ULB

Name: ULB Code:
Designation: ULB Name:
Date:

Prepared by