(1) The Local Level Committee shall send to the Board the particulars of the applications received by it and the orders passed thereon, every three months.
(2) The Local Level Committee shall carry out an assessment of the functioning of the guardianship at regular intervals to be determined by it in consultation with the registered parents associations and send a resume of the work done, to the Board once in six months.
15. Miscellaneous Any thing not covered under these regulations, may, with the previous approval of the Central Government be determines In accordance with the order of the Board, till such time as the Board may draw up the amendment regulations 21 Form-A [See regulation 5(1)] Application Form Form of application for registration of a voluntary Organization/association of parents/Association of Persons with Disabilitvfto be filled in English or Hindi only)
1. Organisation:
Name:
Address:
Phone/Fax/Telex(office):
(Project):
2. (i) Name of the Act under which registered:
(ii) Registration No. and date of regjstration(Please attach a photocopy):
3. Memorandum of Association and Bye-laws (Please attach a photo Copy):
4. Name, address, occupation and other Particulars of the members of the Board of Management/Governing body;
5. Present activities of the organisation:
6. Present membership strength and Categorization:
List of documents to be attached:
(a) A copy of the annual report For the previous year,
(b) Audited Statements of accounts Duly certified by Chartered Accountant For the last two years.
(i) Receipt and Payment Account (by Chartered Accountant) for the last Two years,
(ii) Income and Expenditure Account (by Chartered Accountant) for the last two years
(iii) Balance sheet for the last two years (by Chartered Accountant)
(c) Details of staff employed.
(d) Details of beneficiaries to be covered
(e)_ If hostel is maintained, the number Of hostellers,
(f) Other items, if any, 22 THE GAZETTE OF INDIA: EXTRAORDINARY IPARTH—SEP. 3(i)l
(g) Whether located on its own/rented building (necessary evidence to be attached).
, Name: Signature of Authorised Signatory Address: Designation:
Office Stamp: Date:
A Photocopy/Typed copy/copy retrieved from website at - sociaijustice.nic.in will be acceptable.
Ministry of Social Justice and Empowerment, Government of India.
Form-B [See regulation 6(2)] FORM FOR GRANT OF RESGISTRATION (Under section 12(4) of the Act) Registration No Date:
, • , - • ...... ^ ..-,. F - ••• r • T .!••••• I I ,,,.... T + + . . t 1 t I t I 1 t < < 1 1 I I I I I t t I T t t I I I I I I I F T I • I I 1 T I I • 1 (Name of Institution with full address) i . . • • , , , . t , i . i t * « ' t i i t • ' r i i t ' t l t l 1 t l 1 1 t i l JI • .
is registered by the National Trust, the registration no which shall remain valid up to unless suspended or cancelled by an appropriate order of the Trust.
Signature of the Registration Authority (Seal) Form-C | See regulation 6(3)] FORM FOR RENEWAL OF REGISTRATION I ' l l t t I t I I I I 1 t - r t I I_F. •• • - - * t t i t i i . , 1 f f * f - , * * T ' , I •, (Name of organization with full address) * < ' * * > T " 1 • • 1 * T T . , , - - 1 , , , T , T . . . ̂ , , .,.,,, is registered with the National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities, (Ministry of Social Justice & Empowerment, Govt.of India) for participation in its programmes. Registration number allotted is which is valid from to The number may please be quoted in all future correspondence with the National Trust.
P l a c e : Signature Date :
(Seal) 23 Form-D [See regulation 12(1)] Form of application to the Local Level Committee by a patient, relative or a registered organization for appointment of guardian for a person with disability ^ From Date:
To Local Level Committee Sir/Madam, is a person with disability and requires protection of his person and property through a guardian. We hereby request that be appointed as a guardian of the said for the protection of his person and property.
We furnish hereunder further details and request early decision:
1 .Particulars of the person to be provided guardian.
Name:
Age:
Nature of disability:
Address:
2. Particulars of the person proposed to be appointed as guardian.
Name:
Age:
Relationship with the ward, if any:
Address:
We enclose herewith disability certificate of the said obtained from .
Yours faithfully, Witnesses Authorised Signatory 1 Witness Name:
2nd Witness Designation:
Office Stamp 24 THE GAZETTE OF INDIA : EXTRAORDINARY [PARTII—SEC. 3(i)l Consent of the person proposed to be appointed Guardian I hereby agree to be the guardian of the person and property of And shall discharge my obligations with due diligence.
Signature:
Name:
Date:
Consent of the Guardian , if any, to the aforesaid proposal I hereby agree to the above proposal to appoint as the guardian of Signature:
Name:
Date:
Form-E [See regulation 12(8)] Form of confirmation of appointment of guardian on application made by (1) a registered organization, or (2) parent or relative of person with disability.
The Local Level Committee situated at having considered the application made by for appointment of guardian for hereby confirms its decision as under:-
1. Name of the Ward:
2. Name of the guardian
3. Obligation of the guardian
(a) Maintenance and residential care
(b) Management of immovable property
(c) Management of a movable property
(d) Any others:
The guardian shall furnish property returns to this Committee as per Form C and Form D under these rules.
Place :
Date:
Signature (s):
Stamp:
Printed by the Manager, Govt, of India Prciw, Ring Road, Mayapun, New Delhi-110064 and Published by the Controller of Publications, lJelhi-110054 — 2001.