No.

RT-25029/02/2016-RS
Government of India
Ministry of Road Transport and Highways
(Road safety Cell)
Transport Bhavan,1, Sansad Marg, New Delhi – 110001
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Annexure – A

Form for seeking financial assistance for administering Road Safety Advocacy

Sl. Subject Particulars

No.
01. Name of the Agency:
02. Legal Status:
 Year of Establishment: 1st January, 1994
 Registered under Section of XXI of Societies Registration Act, 1860
(Regd. No. 19815/43 of 1995-96, dt. 23/09/1995)
 Registered under section 6(1) (a) of the Foreign Contribution (Regulation) Act,1976
(FCRA Registration No. 104860173 of 2009-10, dt. 22/09/2009)
 Registered under Section 21A of Income Tax act 1961
(Regd,. No. 12A/481-37/2009-10 dated 31/03/2010)
 PAN no. AAATW0620Q
 SSBE Registration No. 211207886/DIC, Cuttack,26.03.2004
 Coir Board Registration No.; CB/IE/RO/BBSR/OR/587, dt.16/02/2012.
03. Date of registration / incorporation 23.09.1995
04. Contact Number: Email id: gensecywcws1@hotmail.com
wcwsminati@gmail.com
05. Postal Address Women & Child Welfare Society
At- Gamhandia New Colony, Po- Buxibazar,
Dist & City- Cuttack-753001, Orissa, India.
website: http:www.wcwsodisha.simplesite.com
06. Bank Account No. and IFSC Code of the Branch with Address
Name of the Bank and address of Branch Indian Overseas Bank, Cuttack Branch,
P. K. Parija Road, Opp. Howrah Motor,
Po-Buxibazar, Cuttack-753001, Odisha
Name of account holder(s) Account No-002201000020302
Savings Bank Account
Whether single/joint Operation Joint Operation
RTGS Code IOBA0000022
MICR 753020002
Whether the bank has electronic transfer Yes
facility
07. Name, Address and Aadhar Number of the
President / Secretary / Trustee of the agency

08. In case of NGO, please furnish-
(i) Date of registration on DARPAN Portal
(ii) Unique ID generated on DARPAN Portal
09. Brief on the activities conducted by the
Agency in past three years (Attach additional
sheets, if necessary)
Planning Commission, Govt. of India, Unique ID No. NGO
as generated in www. ngo.india.gov.inOR/2009/000305,
dt. 24/7/2009
Attached.
10. Whether any road safety awareness Attached.
programmes have been earlier conducted by
the Agency, if yes, give details thereof
(Attach additional sheets, if necessary)
11. Brief of the proposed activity proposed to be Attached.
undertaken indicating the target group, place,
content of the programme and the proposed
time period for conducting the programme
(Attach additional sheets, if necessary)
12. Total estimated cost of the Proposal (Attach a copy Rs. (attached separate sheet)
of the estimate)

Date: (Signature of the Authorized signatory)

Place: Cuttack. [Name and Designation of the Authorized
Signatory]