Please fill up this form, furnishing correct details sought for based on verifiable true state of affairs without causing suppression of any material information which, if resorted to, shall entail prosecution under the Act.

1. Name and full address of the applicant :
2. Date of Establishment :
3.(A) Whether Registered under the Societies
Registration Act, 1860 (21) of 1860 or any other :
Relevant Act
(B) If yes, number and year of registration :

4. Whether affiliated to a Government Recognised
Board (applicable to Educational Institutions) :

5. Names and addresses of Managing Committee :
Members and occupation of office bearers

6. Name and designation of the official(s) :
authorized to receive the grant

7. Number of Consumer clubs to be set up (with
details of schools affiliated to a Govt. recognized :
Board where clubs are to be established)

8. Amount of grant required :

9. Details of activities to be undertaken by each
Consumer Club along with time schedule for :
completion of activities

10. Details of previous grant, if any taken from :
Department of Consumer Affairs

11. Copies of the following documents
to be attached
(i) Constitution of the Organization and :
and Articles of Association
(ii) Annual Report and Audited Statement of :
Accounts for the last 3 years
(iii)Attested copy of Registration Certificate :
(iv)Copy of letter of affiliation to a Govt.
recognized Board (applicable to educational :
institutions)
(v) Affidavit in the prescribed proforma :

DECLARATION

(To be signed by the applicant or its authorized agent)

The particulars heretofore given are true and correct. Nothing material has been suppressed. It is certified that I/we have read the guidelines, terms and conditions governing the scheme and undertake to abide by them on behalf of our organization/institution. The financial assistance, if provided, shall be put to the declared use, for promotion and protection of rights of consumers or for standard marks. (Strike out whichever is inapplicable).

APPLICANT

To,
The Member Secretary (Committee), Consumer Welfare Fund, Krishi Bhawan, New Delhi.