Declaration Template: Indicator 3.

4A
Data required for Q3:
Public Toilets
Total number of Public Toilets in the ULB: _______________
Whether 100% of the PTs have/are the following:
1) Separate Sections for Men and Women: Yes  No 
2) Dry and clean: Yes  No 
3) Running water/functional flush system or Tap Yes  No 
4) Well lit with electricity connection /naturally lit Yes  No 
5) Functional Bolting on all doors Yes  No 
6) Caretaker for maintenance Yes  No 
7) Open between 6am and 10 pm Yes  No 
8) Differently abled friendly Yes  No 
9) Sanitary napkin dispenser in place 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