The annual report of the Department dealing with Empowerment of Persons with Disabilities in the Government shall include a Chapter on the State Fund.
1044 LA GAZETTE DE L'ETAT [PART–II FORM-I [See Rule 7 (1)] APPLICATION FOR CERTIFICATE/ RENEWAL OF REGISTRATION 1 Name of the Organization/Institution :
2 Administrat ive Office : Address, :
Phone Number and e-mail ID of the Organization/Institution.
3 P l ace o f I ns t i t u t io n : Ad d res s , :
Phone Number and e-mail ID of the Organization/Institution.
4 Applicant is – :
An Organization, registered under the Societies Registration Act, 1860 (Act XXI of 1860).
A Public Trust, registered under any law for the time being in force.
Indian Red Cross Society or its branches.
Company registered under section 25 of the Companies Act, 1956.
Any other Organization (Details of Registration with the name of the Act) which may be recognized by the Ministry for the purpose of this Scheme (Details of Registration with the name of Act) (Copy to be enclosed).
1045PART–II] LA GAZETTE DE L'ETAT 5 Date o f Regis t r a t ion o f t he :
Organization/Institution.
6 Brief history of the Organization/ :
Institution and of its objects and activities.
7 Ty p e o f s e r v i c e s r e n d e r e d b y Organization/Institution (indicate specified disability).
8 Whether recognized by the State :
Government, if yes, provide details.
9 Copy of previous Cer t i f ica te o f :
Registration issued under section 51(2) of Rights of Persons with Disability Act, 2016.
1 0 Whether located in its own or rented :
building and provide address details.
if rented, enclose rental agreement copy.
11 Present number of differently abled :
beneficiaries (Sl. No., Name, Address, Age, Sex, Type of specified disability. % of disability and date of admission).
1 2 Building Documents – :
(a) Building licence from Tahsildar/ PPA approval.
(b) Building Structural Stability Certificate from Public Works Department Engineer/Chartered Engineer.
(c) Blue Print of the Building map drawn by qualified Engineer.
1046 LA GAZETTE DE L'ETAT [PART–II
(d) San i t a ry Ce r t i f i ca t e f ro m District Health Authority.
(e) N O C f r o m F i r e S e r v i c e Department.
1 3 Whether trained staff and other suitable facilities for undertaking the project are available. If so, give details.
In case , new s t a f f i s t o be appointed, furnish details of the q u a l i f i c a t i o n s , a c a d e mi c , professional and experience prescribed for the purpose.
Number of employees working in the organization - whether they are full-time or part-time (Recognised by Rehabilitation Council of India.).
1 4 Li s t o f p ap e rs / s t a t ement s to b e :
attached:
(a) Constitution of the Organization
(b) Const i tut ion of Board o f Management with particular of each Member.
(c) Annual report fo r the pas t three years.
(d) In c o me a n d Ex p e n d i t u r e Accounts and Receipt and Payment Accounts, duly audited by a Chartered Accountant or Government Auditor for the past three years for the organization as a whole (along with copy of the certified balance-sheet form of the previous financial year for the organization as whole).
1047PART–II] LA GAZETTE DE L'ETAT
(e) A statement giving details (year, purpose, amount, etc.,) of assistance received during the last five years from the Central/ State Government Institution including requests made thereof to any one o f those o r any other organization.
(f) A statement giving item–wise and yea r -wise d e ta i l s o f e s t i ma t e d r e c u r r i n g a n d non-recurring expenditure for the past three years.
(g) A statement indicating equipment, apparatus, furniture, library books, etc., (by number of details whichever is possible) already available and separate statement ind ica t ing the ab ove i tems p u r c h a s e d y e a r -wi s e wi t h financial assistance from the Government of India for the past three years.
(h) Details of budget estimate of the organization as a whole exhibiting the estimated receipts and expenditure during the year for which grant sought for.
1 5 Access facilities provided (Building :
campus and others to differently abled persons).
1 6 Recreation/Sports facilities :
1 7 P r o v i s i o n o f r e a s o n a b l e accommodation according to the individual requirements (specify the details).
1 8 Transport and attendant facilities for :
children with disabilities having high support needs.
1048 LA GAZETTE DE L'ETAT [PART–II 1 9 List of additional papers, if any :
2 0 List of additional information, if any:
Place : Signature of the applicant Date : Name:
Seal:
APPENDED TO FORM-I ANNEXURE-A (FOR DAY CARE INSITITUTIONS) I. Accessibility of Building
1. No. of floors in the Institution :
2. Whether lift/ramp available :
3. If yes, mention the No. :
4. If no, mention the alternative facilities :
available for easy mobility of PWDs.
5. No. of adoptable toilets for male :
6. No. of adoptable toilets for female :
7. Whether safe flooring/tactile flooring :
available.
II. Safety Measures
1. Whether s tructura l s tabi l i ty i s :
monitored periodically and if yes, how?
2. Whether NOC from Fire Department:
obtained. (enclose a copy).
3. Whether fire safety facilities installed:
and mention No.
4. Whether electrical fixtures/installation :
checked periodically and safety ensured.
1049PART–II] LA GAZETTE DE L'ETAT III. Health and Sanitation
1. Whether safe dinking water available :
2. Whether envi ronment/premise i s :
cleaned regularly.
3. Whether toilets cleaned regularly :
4. M en t io n a r r a ng e me n t s fo r p es t :
control.
IV. Education and Training
1. Whether the professionals are :
registered with RCI please furnish list of professionals with their qualification and RCI Registration No.
2. Mention the type of teaching method :
and under which Insti tution i t is affiliated.
3. Please furnish the list of vocational :
training imparted to the differently abled persons.
4. Please ment ion ar rangements for :
follow up of discharged students/ inmates.
Place: Signature.
Date :
APPENDED TO FORM-I ANNEXURE-B (FOR RESIDENTIAL CARE INSTITUTIONS) I. Accessibility of Building
1. No. of floors in the Institution :
2. Whether lift/ramp available :
3. If yes, mention the No. :
4. If no, mention the alternative facilities :
available for easy mobility of PWDs.
5. No. of adoptable toilets for male :
6. No. of adoptable toilets for female :
7. Whether safe flooring/tactile flooring :
available.
1050 LA GAZETTE DE L'ETAT [PART–II II. Safety Measures
1. Whether structural stability is :
monitored periodically and if yes, how?
2. Whether NOC from Fire Services :
Department obtained. (enclose a copy).
3. Whether fire safety facilities installed, :
mention No.
4. Whether electrical fixtures/installation :
checked per iodical ly and safety ensured.
III. Health and Sanitation
1. Whether safe drinking water available :
2. Whether environment/premise is :
cleaned regularly.
3. Whether toilets cleaned regularly :
4. Mention arrangements for pest control :
IV. Education and Training
1. Whether the professionals are :
registered with RCI. Please furnish list of professionals with their qualification and RCI Registration No.
2. Mention the type of teaching method :
and under which Insti tution i t is affiliated.
3. Please list of vocational training :
imparted to the inmates.
4. Please mention arrangements for :
follow up of discharged students/ inmates.
1051PART–II] LA GAZETTE DE L'ETAT V. Food/Clothing and other Amenities
1. Whe ther c leanl iness o f ki tchen/ :
groceries/vegetables are monitored daily.
2. Whether diet scale for providing :
minimum nutr i t ional s tandard i s followed. If yes, enclose a copy.
3. Details of the daily routine of the :
inmates may be furnished.
4. Whether sufficient clothing and :
bedding items are supplied. Give a list and interval of supply.
5. Whether mobility equipments such :
as wheel chair, crutches are provided to inmates?
6. What are the recreational facilities :
made available to inmates.
7. Whether accommodation facilities :
available to inmates are sufficient.
please give details.
8. Facilities available for washing clothes :
of inmates.
VI. Health Facilities
1. Details of medical facilities available :
2. Whether first-aid kit maintained and :
the person hand holding the kit is trained for proper usage.
3. Please mention the arrangements for :
regular health care and treatment d u r i n g s i c k n e s s / a c c i d e n t a t Institutions.
4. In case of child inmates whether, :
immunization is carried out.
Please furnish details.
Date : Signature.
Place:
1052 LA GAZETTE DE L'ETAT [PART–II GOVERNMENT OF PUDUCHERRY DIRECTORATE OF SOCIAL WELFARE FORM-II CERTIFICATE OF REGISTRATION [See rule 7(5)] Dated:
Registration is awarded/renewed to .................................................
................................................. as an Institution for the Persons with Disabilities vide S.No. .............................. under section 51 (2) of the Rights of Persons with Disabilities Act, 2016 to run a residential/ non-residential institution. This Certificate of Registration is valid for the period commencing from .................. to ....................... and is subject to the following conditions:-
1. Application for granting renewal of a Certificate of Registration should be submitted to this Office sixty days in advance before the expiry of the period of validity.
2. The Management should not appoint any staff whose certificate has been cancelled or who has been convicted for offence involving moral turpitude.
3. The Institution should provide proper infrastructure facilities including sufficient accommodation to differently abled children.
4. The building licence should be duly renewed periodically.
5. The Management should appoint persons with Bench mark as per section 34 (1) of the RPD Act, 2016.
6. This Certificate should be displayed by the Institution in a conspicuous place.
1053PART–II] LA GAZETTE DE L'ETAT
7. Institution should follow the rules/regulations issued by the Government Authority from time to time.
8. Necessary fire safety facilities should be properly installed at the appropriate scale as indicated by the Fire Services Department.
9. Structural Stability Certificate, Sanitary Certificate, Building Licence and No Objection Certificate from Fire Services Department should be renewed periodically without fail.
10. The Institution is subjected to inspection by the inspection authorities under the Act/Rules and by the persons/officers authorized by the State Government.
11. The Certificate of Registration is liable to be revoked as the provisions given in the section 52 of the RPD Act, 2016.
12. The Institution shall properly create structural accessibility of the premises.
The registration shall be subjected to the conditions laid down in the Persons with Disabilities Act, 2016. The Institution should comply with rules/regulation/instructions issued by the State Commissioner for the differently abled from time to time.
Seal Signature.
———— online publication at “https://styandptg.py.gov.in” Published by The Director, Government Press Printed at: Government Central Press, Puducherry.
Posted at: Puducherry HPO on every Tuesday