1. Name of the Voluntary Agency _______________________________ _______________________________________________________________ _______________________________________________________________

2. Postal Address of the Voluntary Agency _____________________ _______________________________________________________________ _______________________________________________________________

2.1 District and State/U.T. where situated ____________________

PIN ________________ 3. Contact Person: (name) _____________________________________

3.1 Telephone _______________ (o) _______________(R) __________
Fax No. _________________ Telex _____________ Gram ________
E-mail _____________________________

4. Nature of Voluntary Agency
(1) Publicity Trust
(2) Association
(3) Non Profit organisation
(4) Others

5. Registration Number _______________________ ______________________ year of Registration ____________________

6. Whether All India organisation (Yes or No). If yes, please furnished information as per guidelines.

7. (a) Does the organisation have any previous experience in adult literacy work ?
(b) If yes, was any grant sanctioned from Government of India?
(c) If yes, give details as shown below:
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Sanction No. And Date

Area of operation

No. of Adult

Period of implementation

Whether accounts

Date	i. Block	Education	Sent or not
	ii. No. of Panchayat	Center/JSN if center based
	iii. No. of villages programme)

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8. Whether the office of the organisation is located in own building or rented building? Please indicate details or accommodation available.

9. If the headquarters of the Voluntary Agency is far away from the Proposed project area, complete address of ther place where the sub-office or branch office will be located in the proposed project area.

10.Please attach Project Proposal formulated in a separate sheet as per Appendix III.

11. List of documents to attach
(a)Attested copy of Registration certificate
(b)Copy of Memorandum of Association
(c)Copy of Articles of Association
(d)List of Members of Governing body with address and occupation (latest)
(e)Audited account for the last three years, namely, Receipt & payment Account and Income & Expenditure Account.
(f)Copy of latest Balance Sheet
(g)Copy of latest annual report
(h)Proceedings of Board of Management/Executive Committee during the preceding year.

12. Brief History of the Agency, its objects, and activities. ------------------------------- ------------------------------- -------------------------------

13. Brief summery of the activities taken up and results achieved during previous year.

14. Additional papers/information, if any.