FORM NO.

10A [See rule 17A/11AA/2C]

Application for registration or provisional registration or intimation or
approval or provisional approval
Acknowledgement Number -136555750070324

Incorporation/constitution details
1. PAN AAATB5091L

2. Section Code 12-Sub-clause (A) of clause (iv) of

first proviso to sub-section (5) of
section 80G

Category -

Do you have earlier issued registration/approval certificate? -

3. Nature of activities Charitable

4. Type of constitution Society

4a. Whether the applicant is established under an instrument? Yes

4b. Date of Incorporation/Creation/Registration 22-Jun-2000

4c. Registration or Incorporation Number 292 OF 2000-01

4d. Authority Granting Registration/Incorporation SOCIETIES REGISTRATION

ACT-1860

5. Objects of the applicant Relief of the Poor

Education
Medical Relief
Yoga
Preservation of Environment
(including watersheds, forests and
wildlife)
Advancement of any other objects
of general public utility

6. Whether the trust deed contains clause that the trust is irrevocable -

Other registrations
7. Whether the applicant is registered on DARPAN portal or under FCRA Yes
Act or any provision of Income-tax Act?

Sl. No. Relevant Law/ Registration No. Date of Authority Date from which
Portal Registration granting registration is
registration effective

1 FCRA, 2010 031270029 09-Aug-2016 Ministry of 01-Nov-2016

Sl. No. Relevant Law/ Registration No. Date of Authority Date from which
Portal Registration granting registration is
registration effective
Home Affairs

2 Others 29 OF 2001-02 11-Jan-2002 INCOME TAX 01-Apr-2001

COMMISSIONER,
MUZZAFARPUR

8a. Whether any application for registration made by the applicant in No

the past has been rejected?

8b. Whether claiming exemption under clause 21 of section 10 No

Income-tax Act

Details of key persons

9a. Details of all the Author (s)/ Founder (s)/ Settlor (s)/ Trustee (s)/
Members of society/ Members of the Governing Council/ Director
(s)/ shareholders holding 5% or more of shareholding/ Office
Bearer (s) as on the date of application:

Sl. No. Name Relation Percentage ID Code Name of Unique Mobile Email
of the Unique Identificat number Address
shareholdi Identifier ion
ng in case Number
of
shareholde
r(%)

1 PETER Member - 01- - ANUPG22 87891615 PETERGO

SEBASTIA of the Permanent 42H 20 VEAS@GM
N Governing Account AIL.COM
GOVEAS Council Number

2 HENRY Member - 01- - ABEPF88 91999820 bdsss@red

FERNAND of the Permanent 44Q 53 iffmail.co
O Governing Account m
Council Number

3 FINTON Member - 01- - BXSPS83 91999820 BDSSS@R

SAH of the Permanent 98P 53 EDIFFMAI
Governing Account L.COM
Council Number

4 CHAMBER Member - 01- - DQPPB66 79798722 bdsss@red

LEEN of the Permanent 10D 43 iffmail.co
BERKUMA Governing Account m
NS Council Number

5 PASCCAL Member - 01- - BCNPJ70 94722826 PASCALA

ANAND of the Permanent 33C 00 NAND@GM
JOSEPH Governing Account AIL.COM
Council Number
Sl. No. Name Relation Percentage ID Code Name of Unique Mobile Email
of the Unique Identificat number Address
shareholdi Identifier ion
ng in case Number
of
shareholde
r(%)
6 TOBIAS Member - 01- - AWNPT94 91109659 toppotob
TOPPO of the Permanent 34G 84 ias46@gm
Governing Account ail.com
Council Number

7 HARMAN Member - 01- - BWSPR76 77819591 HERMAN6

RAPHAEL of the Permanent 51B 11 20209@G
Governing Account MAIL.CO
Council Number M

9b. In case if any of persons (as mentioned in row 9a) is not an

individual then provide the following details of the natural persons
who are beneficial owners (5% or more) of such person as on the
date of application:

Sl. No. Name ID Code Name of the Unique Percentage of

Unique Identifier Identification beneficial
Number ownership(%)
No Records
Added

Assets and liabilities

10. Has return of income been filed for the last assessment year for which Yes
the due date has expired

11. Corpus ₹0

12. Funds/reserves and surplus other than corpus ₹0

13. Long term liabilities ₹0

14. Other liabilities ₹0

Total liabilities ₹0

15. Land and Building ₹0

16. Other fixed assets ₹0

17. Investments/deposits made into one or more of the forms or modes ₹0

specified in sub-section (5) of section 11

18. Investments/deposits other than mentioned in row number 17 above ₹0

19. Other assets ₹0

Income Details
20. Income received in three previous years immediately preceding
the previous year in which application is made:

Sl. No. Financial Year Grants Grants Other Specific Other Income Total
received from received from Grants
Central or Companies
State under
Government Corporate
Social
Responsibility

1 2022 ₹0 ₹0 ₹0 ₹ 96,57,750 ₹ 96,57,750

Religious activities
21a. Whether the fund or the institution has incurred any expenditure of No
religious nature

21b. If yes, please provide the following details for three previous years
immediately preceding the previous year in which application is
made:

Sl. No. Financial Year Total Income Expenditure of Percentage to Total

Religious Nature Income(%)
No Records
Added

Verification
I HENRY FERNANDO, Son / Daughter of LAZER FERNANDO, hereby declare that the details given in the form
are true and correct to the best of my knowledge and belief.
I undertake that I am applying for registration/approval under the section code 12 and the activities of the
BETTIAH DIOCESAN SOCIAL SERVICE having Permanent Account Number (PAN) AAATB5091L have not
commenced on or before the date of making this application.
I further undertake to communicate forth with any alteration in the terms of the Society, or in the rules
governing the Institution ,made at any time hereafter. I also declare that I am filing this form in my capacity as
TRU (designation) having PAN ABEPF8844Q and that I am competent to file this form and verify it.

Name: HENRY FERNANDO

Designation TRU

Address Bishop's House, Supriya Road,

shantinagar, Bhawanipur B.O, WEST
CHAMPARAN, Bihar, INDIA -
845438

Place WEST CHAMPARAN

IP Address 27.60.101.1
Date 07-Mar-2024

Acknowledgement Number - 136555750070324

Income Tax Form submitted electronically on 07-Mar-2024 04:44:31 PM from IP Address 27.60.101.1 and
verified by - having PAN/TAN ABEPF8844Q on 07-Mar-2024 04:44:25 PM using Electronic Verification Code
TIUD56CWCI generated through Aadhaar OTP mode.