Inspection Proforma

1. Name of NGO: _______________________________________________

2. Area of Operation: ____________________________________________

3. Complete Address with Phone No: ________________________________

____________________________________________________________

4. Date of establishment: __________________________________________

5. Date of applying for registration: __________________________________

6. Registration Authority: _________________________________________

7. Number and Date of registration if already under any other Law:__________

8. Aims & objectives of NGO:

1. __________________________________________

2. __________________________________________

3. __________________________________________

4. __________________________________________

5. __________________________________________

9. Is comprehensive Plan of Action Attached? Yes: _______ No: _________

9-A Brief picture of Present Activities.

Sr. No.	Field /Area of Services	Units	Staff	Location	Average No. of Beneficiaries
1
2
3
4
5

9-B Proposed field wise future Programs.

Sr. No.	Field /Area of Services	Location	Estimated Cost
			Self contribution	Govt. Grant
1
2
3
4
5

10. Is NGO having Paid Staff? Yes: _______ No: _________

10-A If yes detail of paid staff

Sr.No	Name	Designation	Qualification	Salary P.M	Date of Appointment
1	2	3	4	5	6

11. Detail of Voluntary Staff.

Sr.No	Name	Designation	Qualification	Field of Services	Date of Appointment
1	2	3	4	5	6

12. Is following Record of NGO Maintained. Yes: ______ No: ________

.

Sr. No	Record	Completed	Not completed
1	Cash Book
2	Leger
3	Stock Register
4	Minutes
5	Membership Register
6	Inspection register
7	Others

13. Is proposed Constitution field in properly Yes: ______ No: _________

14. Elections tenure 1-Y, 2-Y 3-Y

a) When the last meeting was actually held? ______________.

15. Membership.

Is List of Gerneral Body containing I.D Cards Nos of members? Yes____ No___

Are attested Photo Copies of I.D cards Attached? Yes ______ No _______

a) Total membership of NGO: ___________________________

b) Ordinary Members: _________________________________

c) Life Members: _____________________________________

d) Are members paying membership fee regularly? ___________

16. Executive Body.

Sr.No	Designation	Name	Date of holding this office	Remarks
1	President
2	Senior Vice President
3	Vice President
4	General Secretary
5	Joint Secretary
6	Finance Secretary
7	Press Secretary

a) Executive Members.

1	Executive member
2
3
4
5
6
7
8

17. What are the Sources of Funding of NGO

a) Aid from Govt: and other Agencies: ______________________

b) Donation received from Public: __________________________

c) Contribution made by General/Executive Body: _____________

d) Grant received from any other source: _____________________

18. Financial Status.

a. Bank Account No. ___________________

b. Is Bank Statement showing income and expenditure Attached? ________

c. Present Balance: _______________

19. Has Organization potential to become self- sufficient. Yes______ No _____

19-A whether the verification reports of agencies obtained? Yes______ No _____

20. Is Deputy District Officer SW Visited NGO personally? Yes _____ No _____

20-A If yes Recommendation of Deputy District Officer, SW: __________

______________________________________________________________

21. Is District Officer, SW visited NGO personally? Yes_____ No ______

21-A If yes Recommendation of District Officer, SW: _________________

_______________________________________________________________

Are the following documents duly completed Annexed with the case?

· Plan of Action

· Minutes of Meeting

· Affidavit regarding non-affiliation with political party/sectarian group.

· Receipt of Rs,100/-

· Feasibility report of Deputy District Officer, SW/District Officer, SW

Recommendations of the District Officer.