In case of a counseling centre, details under column 19 to 25 are to be entered after inspection by registering authority
19. Number of counselors in the, centre :3
20. Minimum qualification of the counselors, specify 0 Under graduate 0 Graduate 0 Post graduate.
❑ Diploma holder 0 Professional degree ['Any other, 'specify
21.. Experience of the counselors ❑ Less than a year 01 year 0 2 years 0 3 years ❑ More than 3 years
22. Professional qualification/experience of counselors 0 Professional degree 0Experience in family counseling as a (designation) in, the (Name of the organization) THE GAZETTE OF INDIA:EXTRAORDINARY jpv 301 [ gm II --IFT3(i)] %MT/FIRM% : Mr114711 81 4 ❑ Experience in psychiatric counseling as (designation) in the (Name of the organization) ❑ Any other relevant experience, please specify 1 1
23. Whether a list of names of...counselors along with their qualifications has been annexe'd El Yes ❑ No
24. Type of counseling provided ❑ Supportive one-to-one counseling ❑ Cognitive behavioural therapy (CBT){Mental process that people use to remember, reason, understand, solve problems and judge things} ❑ Providing counseling to a group of people suffering ❑ Family counseling . Facilities provided ❑ Offering personal professional and confidential counseling sessions ❑ A safe environment to discuss problems and express emotions ❑ Information on counseling services, support groups and mental health care resources ❑ One to one counseling and group work ❑ Therapies, ongoing counseling and health related support .
❑ Any.other, please specify SZ THE GAZE1TEOF INDIA:EXI'RAORDINARY [PART 1I—SEC. 3(1)1 0) Any other service
(1) Services being provided (2; Personnel appointed L J
1.
L
(3) Statutory minimum qualifications required for providing such service L
(4) Whether a list of names of Personnel engaged for providing service along with their professional qualification is annexed Yes No
(5) Any other details which the service provider desirous of registration may provide .1f necessary continue on a separate sheet.
Place: Signature of authorised official Date: Designation:
(Seal) IMF TIMIS!: 83 [ sirn II --an 39)] FORM VII [See rule 11(1)] NOTICE FOR APPEARANCE UNDER SECTION 13 (1) OF THE Protection of Women from Domestic Violence Act, 2005 IN THE COURT OF P/S.: ...... ..
IN THE MATTER OF:
........
Mr. .......
To, VERSUS ...COMPLAINANT -RESPONDENT Mr R/o.... ...................
........... ............
WHEREAS the Petitioner has filed an application(s) under section of the Protection of Women from Domestic Violence Act, 2005 (43 of 2005);
You are hereby directed to appear before this Court on the day of 20__ ... at o'clock in the noon personally or through a duly authorized 84 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(01 counsel of this Court to sho'W cause why the relief(s) claimed by the Applicant against you should not be granted, failing which the court shall proceed ex parte against you.
Oiven under my hand and the seal of the Court of on the day of 20..........
Signature Seal of the Court [F . No, I 9-3/2005-WW] PARUL DEBI DAS, Jt. Secy.
— — Printed by the Manager, Govt. of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.