“ârkÂàçy qàçÐ¹þ §çý ¡Âmªàêm »þà§ý ÎàäÌ§ý §çý

qÞkãuÂà §íýtàÞ§ý

ÂàªàÀ säªàmàÂà (ârÂàà »þà§ý â¹þ§ý¹þ) §çý Zàçx½à

“²þ¾mãyªàð¼þ/Àäªàê/09/2013

2015.”

Ñçmä ¡Âàätm. §íýtàÞ§ý kã.2

²þ¾mãyªàð¼þ

ªàk¹þ / 38 ây. yç. âsvà¢ê. âÀÂààÞ§ý

2001.”

²þ¾mãyªàð¼þ ÊàkqØà

(¡yàoàÊ½à)

Zààâo§ýàÊ yç Zà§ýàâÎàm

§íýtàÞ§ý

]

ÊàuqäÊ, tÞªàvwàÊ, âÀÂààÞ§ý 22 ÂàwÈrÊ 2022



¡ªàPÑàu½à 1, Îà§ý 1944

[kk|] ukxfjd vkiwfrZ ,oa miHkksDrk laj{k.k foHkkx

ea=ky;] egkunh Hkou] uok jk;iqj vVy uxj

vVy uxj] fnukad 3 uoEcj 2022

vf/klwpuk

dzekad ,Q 1&34@2018@29&2-⸺ NRrhlx<+ eky vkSj lsok dj vf/kfu;e] 2017 ¼Ø- 7 lu~ 2017½ dh

/kkjk 57 ds izko/kkuksa ds v/khu iznRr 'kfDr;ksa dks ç;ksx esa ykrs gq,] jkT; ljdkj] ,rn~}kjk] miHkksDrk vf/kdkjksa ds

izfr tkx:drk ykus rFkk miHkksDrkvksa ds l'kDrhdj.k ds fy;s fuEufyf[kr fu;e cukrh gS] vFkkZr~%&

fu;e

laf{kIr uke] foLrkj rFkk çkjaHk-& ¼1½ ;s fu;e NRrhlx<+ jkT; miHkksDrk dY;k.k fuf/k fu;e] 2022

dgyk;saxsA

¼2½

budk foLrkj laiw.kZ NRrhlx<+ jkT; esa gksxkA

¼3½

;s jkti= esa buds izdk'ku dh rkjh[k dks izo`Rr gkasxsA

ifjHkk"kk,a-& ¼1½ bu fu;eksa esa] tc rd fd lanHkZ ls vU;Fkk visf{kr u gks]&

¼d½

**vf/kfu;e** ls vfHkizsr gS miHkksDrk laj{k.k vf/kfu;e] 2019 ¼2019 dk la- 35½(

¼[k½

**vkosnd** ls vfHkizsr gS dksbZ ,tsalh@laxBu] tks miHkksDrk dY;k.k xfrfof/k;ksa esa yxk

gks rFkk tks daiuh vf/kfu;e] 1956 ¼1956 dk la- 1½ ;k rRle; izo`Rr fdlh fof/k ds

v/khu rhu o"kZ dh dkykof/k ds fy;s jftLVªhd`r gS] ftlesa xzke@eaMy@lfefr

Lrj@miHkksDrk lgdkjh lkslkbVh fo'ks"k :i ls efgyk] vuqlwfpr tkfr@vuqlwfpr

tutkfr ;k jkT;@dsUnz ljdkj }kjk izk;ksftr ;k pyk;s tk jgs laxBu@lkslkbVh

lfEefyr gaSA rFkkfi] rhu o"kZ dh dkykof/k ds fy, jftLVªhdj.k laca/kh vis{kk]

jkT;@dsUnz ljdkj }kjk LFkkfir ,tsalh@lkslkbVh ij ykxw ugha gksxh(

¼x½

**vkosnu** ls vfHkizsr gS bu fu;eksa ds iz;kstu ds fy, bu fu;eksa ls layXu iz:i&d

esa vkosnu(

¼?k½

**miHkksDrk** dk ogh vFkZ gS tks miHkksDrk laj{k.k vf/kfu;e] 2019 ¼2019 dk la- 35½

dh /kkjk 2 dh mi&/kkjk ¼7½ esa mlds fy;s leuqnsf'kr gS rFkk blesa os miHkksDrk oLrq,a

lfEefyr gSa] ftu ij 'kqYd dk Hkqxrku fd;k x;k gS(

¼M-½ **NRrhlx<+ miHkksDrk dY;k.k fuf/k** ls vfHkizsr gS jkT; ljdkj }kjk LFkkfir dh

xbZ fuf/k(

¼p½ **lfefr** ls vfHkizsr gS fu;e 5 ds v/khu xfBr lfefr(

¼N½ **miHkksDrk dk dY;k.k** esa lfEEkfyr gS miHkksDrk ds vf/kdkjksa dk lao/kZu rFkk

laj{k.kA

¼2½ 'kCn ;k vfHkO;fDr;k¡] tks bu fu;eksa esa iz;qDr gSa rFkk ifjHkkf"kr ugha gSa] fdUrq vf/kfu;e esa

ifjHkkf"kr gS] ds ogh vFkZ gksaxs] tSlk fd vf/kfu;e esa Øe'k% muds fy, leuqnsf'kr gSaA

3- jkT; miHkksDrk dY;k.k fuf/k dh LFkkiuk-& ¼1½ NRrhlx<+ eky vkSj lsok dj vf/kfu;e] 2017 ¼Ø-

7 lu~ 2017½ ,oa dsUnzh; eky vkSj lsok dj vf/kfu;e] 2017 ¼2017 dk la- 12½ ds izko/kkuksa ds varxZr

jkT; miHkksDrk dY;k.k fuf/k dh LFkkiuk dh tk;sxhA fuf/k ds dks"k esa fuEufyf[kr lfEefyr gksaxs%&

¼,d½

NRrhlx<+ eky vkSj lsok dj vf/kfu;e] 2017 dh /kkjk 54 dh mi&/kkjk ¼5½ ds

varxZr fuf/k esa tek dh xbZ jkf'k(

¼nks½

dsUnzh; eky vkSj lsok dj vf/kfu;e] 2017 dh /kkjk 54 dh mi&/kkjk ¼5½ ds varxZr

dsUnz ljdkj }kjk fn;k x;k dksbZ vuqnku vFkok izkjafHkd /ku(

¼rhu½ fuf/k esa tek jkf'k ds fuos'k ls vftZr dksbZ vk;A

¼2½ fuf/k dh jkf'k] ,d i`Fkd lC;kt cSad [kkrs esa tek dh tk;sxhA [kkrs esa tek C;kt dh jkf'k dks

jkT;@LFkkuh; Lrj ds dk;ZØeksa ds foRr iks"k.k gsrq mi;ksx fd;k tk;sxkA

4- miHkksDrk dY;k.k fuf/k ds ys[ks rFkk vfHkys[kksa dk la/kkj.k-& jkT; miHkksDrk dY;k.k fuf/k ls

lacaf/kr mfpr rFkk i`Fkd [kkrk] vk;qDr@lapkyd] [kk|] ukxfjd vkiwfrZ vkSj miHkksDrk laj{k.k }kjk

la/kkfjr fd;k tk;sxk rFkk mls mlh jhfr ls izpkfyr fd;k tk;sxk] tSlk fd jkT; ds yksd [kkrksa esa

fdlh vU; laO;ogkj ds fy;s fd;k tkrk gS rFkk ;g NRrhlx<+ jkT; ds egkys[kkdkj }kjk ys[kk ijh{kk

ds v/;/khu gksxkA

5- lfefr dk xBu-& ¼1½ jkT; ljdkj] jkT; miHkksDRkk dY;k.k fuf/k esa tek /kujkf'k dh Lohd`fr ds fy,

rFkk miHkksDrk ds dY;k.k gsrq bu fu;eksa ds iz;kstuksa dks fØ;kfUor djus dh vuq'kalk djus ds fy, ,d

LFkk;h lfefr dk xBu djsxhA

¼2½

lfefr esa fuEufyf[kr lnL; lfEefyr gksaxs] vFkkZr~%&

¼d½ izeq[k lfpo@lfpo]

v/;{k

NRrhlx<+ 'kklu] [kk|] ukxfjd vkiwfrZ

rFkk miHkksDrk laj{k.k foHkkx-

¼[k½ lfpo] NRrhlx<+ 'kklu]

mik/;{k

foRr foHkkx ;k mldk izkf/kd`r ukefunsZf'krh-

¼x½ lfpo] NRrhlx<+ 'kklu]

lnL;

LokLF; ,oa ifjokj dY;k.k foHkkx ;k mldk

izkf/kd`r ukefunsZf'krh-

¼?k½ lfpo] NRrhlx<+ 'kklu]

lnL;

Ldwy f'k{kk foHkkx ;k mldk

izkf/kd`r ukefunsZf'krh-

¼M-½ la;qDr lfpo

lnL;

miHkksDrk ekeys foHkkx] Hkkjr ljdkj

;k mldk ukefunsZf'krh-

¼p½ vk;qDr@lapkyd]

lnL;

tulaidZ] NRrhlx<+

¼N½ vk;qDRk@lapkyd]

lnL;&lfpo

“ârkÂàçy qàçÐ¹þ §çý ¡Âmªàêm »þà§ý ÎàäÌ§ý §çý

ÂàªàÀ säªàmàÂà (ârÂàà »þà§ý â¹þ§ý¹þ) §çý Zàçx½à

“²þ¾m

yªàð¼þ/Àäªàê/09/2013

2015.”

Ñçmä ¡Âàätm. §íýtàÞ§ý kã.2

²þ¾mãyªàð¼þ

ªàk¹þ / 38 ây. yç. âsvà¢ê. âÀÂààÞ§ý

- 05-

2001.”

²þ¾mãyªàð¼þ ÊàkqØà

(¡yào

àÊ½à)

Zààâo

§ýàÊ yç Zà§ýàâÎàm

¼6½

lfefr dh dksbZ Hkh dk;Zokgh ekU; ugha gksxh] tc rd fd mldh v/;{krk] v/;{k ;k mik/;{k

}kjk u dh xbZ gks vkSj mlesa de ls de rhu lnL; mifLFkr u gksaA

§íýtàÞ§ý

]

ÊàuqäÊ, tÞªàvwàÊ, âÀÂààÞ§ý 22 ÂàwÈrÊ 2022

¼3½

vuqnku ds leqfpr mi;ksx dks lqfuf'pr djus ds fy;s vkosndksa ds ys[kksa dk ys[kk ijh{k.k

djkuk(

¡ªàPÑ

àu½à 1, Îà§ý 1944

¼5½

fdlh vkosnd ;k vkosndksa ds fdlh oxZ dks] vuqnku ds mi;ksx dh vkof/kd fjiksVZ izLrqr djus

dh vis{kk djuk(

¼6½

okLrfod vlaxfr] lkjoku fof'kf"V;ksa esa xyrh ds varoZfyr gksus ds vk/kkj ij vius le{k j[ks

x;s vkosnu dks vLohdkj djuk(

¼7½

vf/kfu;e ds mica/kksa ds vuqlkj fdlh vkosnd ls ns; fdlh jkf'k dh olwyh djukA

9- miHkksDrk dY;k.k fuf/k ls vuqnku ds iz;kstu-& lfefr] fuEufyf[kr iz;kstuksa ds fy, vuqnku

Lohd`r djus dh vuq'kalk djsxh%&

¼1½

dsUnz ;k jkT; ljdkj }kjk fofufnZ"V dh xbZ ;kstukvksa ds dk;kZUo;u ds fy;sA

¼2½

,slh vU; xfrfof/k;ka] tSlk fd jkT; ljdkj }kjk] miHkksDrkvksa ds fgrksa ds lao/kZu ,oa laj{k.k ds

fy;s rFkk jkT; esa miHkksDrk vkanksyu dks l'kDr djus gsrq vko';d le>k tk;sA

NRrhlx<+ ds jkT;iky ds uke ls rFkk vkns'kkuqlkj]

uhye inqe ,Yek] mi&lfpo-

?kks"k.kk

eSa] ,rn~}kjk] ?kksf"kr djrk gw¡ fd esjs }kjk tks Hkh nLrkost izLrqr fd, x, gSa] muesa dksbZ Hkh feF;k ;k

cukoVh ugha gSA eSa@ge ,rn~}kjk izekf.kr djrk gw¡wa@djrs gSa fd eSaus@geus ;kstuk ds leLr fu;e vkSj fofu;eksa

dks i<+ fy;k gS rFkk eSa@ge vkSj gekjk laxBu@laLFkku 'kklu }kjk fn, x, funsZ'kksa dk ikyu d:axk@djsaxsA ;fn

dksbZ foRrh; lgk;rk gesa eatwj dh tkrh gS] rks og jkf'k] miHkksDrkvksa ds vf/kdkjksa ds laj{k.k rFkk miHkksDrkvksa dh

tkx:drk ds fy;s mi;ksx dh tk,xhA

gLrk{kj

uke

iw.kZ irk

fnukad

LFkku

izfr]

lnL; lfpo]

lfefr ¼miHkksDrk dY;k.k fuf/k½

jk;iqj ¼NRrhlx<+½

izk:i&d

1- vkosnd ds uke] iw.kZ Mkd irk lfgr-

2- laxBu dh LFkkiuk dk fnukad-

3- D;k lkslk;Vh] vf/kfu;e] 1860 ¼1860 dk la- 21½ ds v/khu iathd`r gS ;k fdlh vU; lacaf/kr fu;eksa ds

v/khu iathd`r gS-

4- ;fn gk¡] rks iathdj.k Øekad rFkk o"kZ dk mYys[k djsa ¼iathdj.k dh izekf.kr izfr layXu djsa½-

5- D;k laxBu jkT; Lrj ;k jk"Vªh; Lrj ij iathd`r gS-

6- izca/k lfefr ds lnL;ksa ds uke ,oa muds Mkd ds irs rFkk muds miktZu ;k muds thfodk fuokZg dk

rjhdk] lnL;ksa dh lwph lfgr layXu djsa-

7- fiNys rhu o"kZ ds nkSjku laxBu ds mn~ns'; rFkk fdz;kdykiksa ds laf{kIr fooj.k-

8- ;kstuk] ftlds v/khu foRrh; lgk;rk visf{kr gS ¼d`i;k ifj;kstuk rFkk izLrkfor dk;ZØe ds fooj.k

izLrqr djsa½-

9- visf{kr lgk;rk rFkk jkf'k] tks vkorhZ@vukorhZ gS] 'kh"kZokj fooj.k nhft;s-

10- ykWx Qzse ds :i esa vuqdzef.kdk ds lkFk dk;Z ds le;c) 'ksM~;wy-

11- fofHkUu 'kh"kZ ds v/khu vkosnd }kjk pkgh x;h va'kjkf'k dk fooj.k-

12- D;k ,tsalh] dksbZ vf/k'ks"k jde] foRrh; lgk;rk ds :i esa] fdlh vU; 'kkldh; ;k v'kkldh; ,tsalh

ls izkIr dj jgh gS] ;fn gka] rks mldk fooj.k nsa-

13- D;k foxr ikap o"kZ ds nkSjku ,tsalh ds fo:) fdlh izdkj dk vfHk;kstu yafcr gS] ;fn gka] rks iw.kZ

fooj.k nsa-

14- fuEufyf[kr nLrkostksa dh izekf.kr izfr;ka layXu djsa%&

¼1½ laxBu ds xBu rFkk mlds fu;e ,oa fl)kar-

¼2½ foxr rhu o"kZ dh okf"kZd fjiksVZ dh izfr ¼izR;sd o"kZ dh i`Fkd okf"kZd fjiksVZ½-

¼3½ vkWfMVj }kjk gLrk{kfjr foxr rhu o"kZ dh okf"kZd vadsf{kr [kkrs dk fooj.k] vads{kd ds iath;u

Øekad] uke rFkk in dh eksgj ds lkFk iw.kZ irk-

15- ;fn iwoZ esa bl foHkkx }kjk dksbZ lgk;rk nh xbZ gks] rks d`i;k mldk fooj.k nsa-

vVy uxj] fnukad 3 uoEcj 2022

dzekad ,Q 1&34@2018@29&2-& Hkkjr ds lafo/kku ds vuqPNsn 348 ds [k.M 3 ds vuqlj.k esa bl

foHkkx ds lela[;d vf/klwpuk fnukad 03&11&2022 dk vaxzsth vuqokn jkT;iky ds izkf/kdkj ls ,rn~}kjk

izdkf'kr fd;k tkrk gSA

NRrhlx<+ ds jkT;iky ds uke ls rFkk vkns'kkuqlkj]

uhye inqe ,Yek] mi&lfpo-

Atal Nagar, the 3rd November 2022

NOTIFICATION

No. F 1-34/2018/29-2.⸺ In exercise of the power conferred under provisions of

Section 57 of the Chhattisgarh Goods and Services Tax Act, 2017, (No.7 of 2017), the State

Government, hereby, makes the following rules for awareness of consumer rights and

empowerment of consumers, namely:-

RULES

1. Short title, extent and commencement. - (1) These rules may be called the

Chhattisgarh State Consumer Welfare Fund Rules, 2022.

(2) They extends to the whole State of Chhattisgarh.

(3) They shall come into force on the date of their publication in the Official Gazette.

2. Definitions. – (1) In these rules, unless the context otherwise requires, -

(a)

"Act" means Consumer Protection Act, 2019 (No. 35 of 2019);

(b)

"Applicant" means any agency/organization engaged in consumer welfare

activities and registered for period of three years under the Companies Act,

1956 (No. 1 of 1956) or under any other law for the time being in force,

including Village/Mandal/Samiti Level/Consumer Co-Operative Society

Especially Women, Scheduled Castes/Scheduled Tribes or State/Central

Government

sponsored

run

organization/societies.

However,

the

requirements of registration for three years will not be applicable to

Agencies/Societies set-up by the State/Central Government;

(c)

"Application" means an application in Form-A appended to these rules for

the purpose of these rules;

(d)

"Consumer" has the same meaning as assigned to it in sub-section (7) of

Section 2 of the Consumer Protection Act, 2019 (No. 35 of 2019) and

includes consumer of goods on which duty has been paid;

(e)

"Chhattisgarh Consumer Welfare Fund" means the fund established by the

State Government;

(f)

"Committee" means the Committee constituted under rule 5;

(g)

"Welfare of the consumer" includes promotion and protection of rights of

consumer.

(2)

Words or Expressions used and not defined in these rules but defined in the Act

shall have the same meaning as respectively assigned to them in the Act.

Establishment of State Consumer Welfare Fund. - (1) There shall be established a

State Consumer Welfare Fund under the provisions of the Chhattisgarh Goods and

Services Tax Act 2017 (No. 7 of 2017) and Central Goods and Service Tax Act, 2017

(No.12 of 2017). The corpus of the fund shall consist of:-

(i)

The amount credited to the fund under sub-section (5) of Section 54 of the

Chhattisgarh Goods and Services Tax Act, 2017;

(ii)

Any grant or seed money provided by the Central Government under sub-

section (5) of Section 54 of the Central Goods and Services Tax Act, 2017;

(iii)

Any income from the investment of the amount credited to the Fund.

(2) The fund shall be credited in a separate interest bearing bank account. Interest

accrued in the account shall be utilized for financing state/local level programmes.

Maintenance of accounts and records of Consumer Welfare Fund.- A proper and

separate account related to the State Consumer Welfare fund shall be maintained

by the Commissioner/Director, Food, Civil Supplies and Consumer Protection and

operate in the same manner as for any other transactions in the Public account of

the State and shall be subjected to audit, by the Accountant General of the

Chhattisgarh State.

Formation of the Committee.- (1) The State Government shall constitute a

Standing Committee for sanctioning of the money credited to the State Consumer

Welfare Fund and for recommending the Welfare of the consumers to carry out the

purposes of these rules.

(2) The Committee shall consist of the following Members namely:-

(a)

The Principal Secretary/Secretary,

Chairman

Government of Chhattisgarh,

Department of Food, Civil Supplies

and Consumer Protection.

(b)

Secretary, Government of Chhattisgarh

Department of Finance or his

authorized nominee.

Vice-Chairman

(c)

Secretary, Government of Chhattisgarh

Department of Health and Family Welfare

Member

or his authorized nominee.

(d)

Secretary, Government of Chhattisgarh,

Department of School Education

Member

or his authorized nominee

(e)

Joint Secretary, Department of Consumer Member

Affairs, Government of India or

his nominee

(f)

Commissioner /Director,

Public Relations, Chhattisgarh

Member

(g)

Commissioner/Director,

Food, Civil Supplies and

Member- Secretary

Consumer Protection, Chhattisgarh.

(h)

Registrar, Chhattisgarh State Disputes

Redressal Commission.

Member

(i) A representative of State Level Voluntary

Consumer Welfare Organization having

good track record or an expert in the

consumer movement having active interest

and experience regarding working of

Voluntary Consumer Organization/Non-

Government Organization shall be

nominated by the State Government.

Member

Procedure of conduct of business.- (1)

The Committee shall meet as and when

it deems necessary, but not more than three months shall intervene between any

two meetings.

(2) The Committee shall meet at such time and place as the Chairman, or in his

absence the Vice-Chairman of the Committee may deem fit.

(3) The meeting of the Committee shall be presided over by the Chairman, and in

his/her absence, the Vice Chairman shall preside over the meeting of the

committee.

(4) Each meeting of the Committee shall be called, by giving notice in writing to

every member of not less than ten days from the date of issue of such notice.

(5) Every notice of the meeting of the committee shall specify the place and the date

and hour of the meeting and shall contain statement of business to be transacted

there at.

(6) No proceeding of the Committee shall be valid, unless it is presided over by

Chairman or Vice-Chairman and a minimum of three other members are present.

Functions of the Committee.-(1) The Committee shall recommend to the

Government for sanction of grant-in-aid to applicants by taking into account their

financial status, type of work or objectives of their project or activity.

(2) The Committee shall make guidelines for management and administration of the

Fund.

Powers of the Committee.- Committee shall have the power.-

(1) to require from any applicant or any officer duly authorized by the State

Government, to produce any such account books, documents, in written or any

object, as necessary for the assessment of the application;

(2) to require any applicant to allow entry and inspection of any premises, about

which it is stated that activity in such premises is carried on for the welfare of the

Consumer by a duly Authorized Officer of the State Government;

(3) to audit the accounts of the applicants for ensuring proper utilization of the

grant;

(4) to require any applicant, in case of any default or suppression of material

information on his part, to refund in lump sum the sanctioned grant to the

committee and to be subject to prosecution under the said Act and rules made

thereunder.

(5) to require any applicant or any class of applicants, to submit a periodical

report utilization of the grant;

(6) to reject an application placed before it on the basis of involvement of factual

inconsistency, inaccuracy in material particulars;

(7) to recover any sum due from any applicant in accordance with the provisions

of the Act.

9. Purpose of grants from the Consumer Welfare Fund.- The Committee shall

recommend sanction of grants for the following purposes:-

(1)

Execution of schemes specified by Central or State Government.

(2)

Such other activities as may be considered necessary by the State

Government for promotion and protection of interests of the Consumers and

to strengthen the consumer movement in the State.

By order and in the name of the Governor of Chhattisgarh,

NEELAM PADUM ALMA, Deputy Secretary.

DECLARATION

I, hereby, declare that whatever document has been produced, by me, nothing is

false and fabricated. I/We herewith certify that I/we have gone through all the rules and

regulations of the scheme and all the rules and regulations of the scheme and I/We and our

organization/institution will follow the instructions given by the Government. If any

financial aid has been sanctioned to us, that amount will be used for the protection of the

rights and awareness of the consumers.

Signature

Complete Address

Name

Dated

Place

To,

Member Secretary,

Committee (Consumer Welfare Fund)

Raipur (Chhattisgarh)

FORM-A

Name of applicant with complete postal address.

Date of establishment of organization.

Whether the society has been registered under the Act, 1860 (21 of 1860) or has

been registered under any other relevant rules.

If yes then mention the registration number and year (enclose certified copy of

registration)

Whether organization registered under the State Level or National Level.

Mention the name and postal addresses of the members of the management

committee and way of earning or livelihood enclosed with list of members.

Brief details of the organization, its objectives and activities during the last

three years.

Scheme under which financial aid is required for (please submit details of project

and proposed program).

Expected aid and amount which is non recurring/recurring, give details head

wise.

10.

List of work time schedule with index as long frame.

11.

Produce the details of amount to be shared by applicant under different heads.

12.

Is there any surplus amount the agency is getting as a financial aid from other

Government or non Government agency. If yes, then give details.

13.

During the last five years was there any type of prosecution pending against the

Agency. If yes, then give the complete details.

14.

Attach certified copies of the following documents :-

(1) Constitution of organization and its rules and regulations.

(2) Produce last three years annual reports (produce separate annual report for

every year)

(3) Statement of Annual Audited Accounts of the last three years signed by

auditor with Auditor’s registration number name and full address with office

stamp.

15.

If any aid previously has been given by this department,

please

give

the

details.