Organisational Details

Name of the organisation

Address (Regd. Office)

Address (Administrative /
Field Office)

Telephone Number

Fax Number

Email Id

Website

Chief Executive Name

Mobile Number

Email Id

Registration Details

Type of Registration

Registration Number
FCRA Registration Number

12A Registration

PAN No of the Organisation

Financial Details

2009-10 Turnover

2008-09 Turnover

2007-08 Turnover

Staff Details

No. of Staffs (full time)

Segregte with M/F

No. of Staffs (part time)

Segregate with M/F

No. of Volunteers

No. of Consultants

PF for your employees (Say Y/N)

Health Insurance for your
employees (Say Y/N)

Donor Name and number of

year's support

International Donors
National Donors

State Govt. Schemes

Others (please specify)

Programme Staff:
Admin Staff:
NGO Programme Experience Details

Sectoral Experience Name of the Project

Agriculture LEISA

Organic Farming

Rainfed / Dry land /

Irrigated

Cash Crops/Food Crops

Training

Any other specify

Water Watershed

Rain Water harvesting

Water purification
 Any other specify

Energy Biomass

Solar

Wind energy

Any other specify

Livelihood IGP / Enterprise

Any other specify

Insurance Life

Health
 Crop

Livestock

Any other specify

Environment Training Awareness

Afforestation

Climate Change/Global
Warming

Disaster

Solid Waste Disposal

Any other specify

Gender Health & Hygiene

Sensitisation /
Campaigning/Training
Any other specify
Brief Description of the project Name of the Donor
Programme implementing area Project Beneficiaries
(name of the block, number of panchayats and
villages)
(specify with numbers)
 Duration
Amount of Funding Received
(mention starting & ending year)
Any other details, please specify