Application for Animal Birth Control and Immunization of Stray Dogs

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ANIMAL WELFARE BOARD OF INDIA

13/1, Third Seaward Road

Valmiki Nagar, Thiruvanmiyur, Chennai - 600 041

Phone : 044-2457 1024, 2457 1025  Fax : 044-2457 1016

E-mail : awbi@md3.vsnl.net.in  Website : www.awbi.org

 

Name of the Scheme :      Scheme for Animal Birth Control & Immunization of Stray Dogs

 

Application form for new proposal for the year

 

 

1.       Organisation Name                                       :

          Full postal address with pincode                   :

 

 

 

          Tel/Mobile No.                                                :

          (Including STD Code Number)

          Fax No.                                                          :

          E.Mail/ Grams                                                :

          Nearest State Bank of India                           :

          Branch and its Code No.

 

          (i)    Name of the Act under                           :

                  which Registered                                      

          (ii)    Registration No. and                              :

                 date of Registration                                   

                 (Please attach a photocopy)                 

          (iii)   AWBI Recognition Code No.                  :

2.       Whether Govt. body/Municipality/                  :

          Local body/NGO give details                            

 

3.       Registration under Foreign                            :

          Contribution Act                                                                        



4.       Memorandum of Association                         :

          and Bye-Laws

          (Please attach a photocopy)                            

5.       Name and address with phone                     :

          Nos. of the Members of

          Managing Committee/Executive

          Committee/Governing body                          

          (Please attach separate sheet)                    

 

6.       Details of previous grants for the                  :

          last 3 years received from the Board           

 

 

7.       Details of accounts/UC pending                    :

          with you, if any, yearwise.

 

                                                                                               

8.       Details of last inspection done                      :

          (Date & inspection details)

 

 

9.       Details of ABC indicating the                         :

          number of animals to be sterilized

          and immunized in the current

          year and total expenditure                                

          to be incurred for the purpose                      

 

10.     Grant in aid applied for the year                     :

11.     Details of Grant-in-aid                                    :

          received from any other

          Agency/Govt./Dept, if any

          for the same purpose                                                   

 

12.     Details of ABC operations                             :

          carried out in the last 2 years                                                   

13.     Details of infrastructure/facilities                   :

      available with the organization to

      implement the proposed scheme

 

      (a)        Whether you have grazing land            :

                  and Animal Shelter

 

          (b)    Whether you have a Dispensary          :

                  with operation theatre                                                        

  

          (c)    Whether Veterinary Surgeon                :

                  is available                                                                       

            If yes, full time/part time/

            Weekly etc.

 

      (d)        Whether you have para veterinary        :

                  staff, animal handlers, medical

                  equipment                                            

          (e)    Whether you have autoclave                :

       (f)        What is the source of supply                :

                   of dogs, if caught and relocated

                   by NGO itself then certificate

                   as given in Sl.(m) of Annexure

                   to be furnished.                                                                

          (g)    Whether you have your own                 :

                  dog catchers                                                        

 

          (h)    What is your capacity to do ABC          :

14.     Whether adequate water supply                   :

          is available and existing  system

          of drainage.



15.     Does the Organisation have an                     :

      Ambulance?                                                                     

      a)         If yes its make and size

                  How the recurring expenditure

                  is met?                                                 

      b)         Is the driver employed permanent/

                  temporary/as required basis.

16.     Whether entered into MoU with                     :

          Municipality/Corporation.  (Copy

          Of MoU to be enclosed)

17.     Whether you have undertaken a                   :

      dog population survey in your area

18.     Who are the other collaborating                    :

          AWOs in this project?                                                  

19.     How the recurring expenditure                      :

          is met?                                                                                      

20.     What are your animal welfare activities        :

21.     List of additional supporting papers,              :

          if any given:

I/We have read the scheme and fulfill the requirements and conditions of the scheme.  I/We undertake to abide by  all terms and conditions of the scheme.

 

Signature                               :          

Name                                    :           

Address/Seal                        :

Dated                                    :

 

Note   :    Wherever not applicable, especially in case of new Organisations,  please write N.A.