Scheme of Assistance to disabled persons for purchase / fitting of Aids / Appliances (ADIP)

APPICATION FORM FOR New & 1^st INSTALLMENT

(To be submitted in duplicate)

1. ORGANIZATION:

Name:   ________________

Address:   ________________

2. Grant-in-aid applied for:

	Recurring	Non-recurring
1. Applied in the current Year
2. Received as 1st Installment
3. Applied for 2nd Installment

3. Annual Report of the previous year:

4. Statement of account of previous year:

1. Receipt and Payment statement,
2. Income & Expenditure Statement
3. Balance Sheet
4. Audited utilisation certificate with Item wise expenditure as per the sanctioned items of grant

4. Registration No. & Date of Registration:

(under Societies Registration Act & PWD Act 1995 Please attach Photocopies): Yes / No