Declaration for Indicator 3.

4
Data required for Q3:

Urinals:
Total number of Urinals in the ULB: ________ %

Whether 100% of the urinals have/are the following:

1) Dry and clean: Yes  No 
2) Running water for flushing Yes  No 
3) Well-lit natural light/if covered – electricity. Yes  No 
4) Institutional arrangements in place for maintenance/cleaning Yes  No 
5) Differently abled friendly Yes  No 

Documents to be submitted by the ULB for evaluation:

None

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