EXTRAORDINARY
PUBLISHED BY AUTHORITY
No.1897, CUTTAC K, TUESDAY, OCTOBER 9, 2018/ ASW INA 17, 1940
DEPARTMENT OF SOCIAL SECURITY & EMPOWERMENT OF PERSONS WITH
DISABILITIES
NOTIFICATION
The 4thOctober, 2018
No.7648–SSEPD-DA4-DA-0004/2018/SSEPD— In exercise of the powers conferred by sub-sections (1) and (2) of Section 101 of the Rights of Persons with Disabilities Act, 2016 (49 of 2016), the State Government do hereby issues the following corrigendum to Odisha Rights of Persons with Disabilities Rules, 2018:—
"Form-II" and "Form-III" in Odisha Rights of Persons with Disabilities Rules, 2018, shall be replaced with "Form-II" and "Form-III" annexed herewith respectively.
2FORM - II
[See rule 8(1)]
APPLICATION FOR REGISTRATION OF INSTITUTION WORKING IN THE FIELD OF
DISABILITIES
(To be submitted in duplicate)
1. Basic Information
1.1* Name of the Applicant Organization
:
1.2* Complete Postal Address with Contact No. and E- Mail Id :
1.3* Name, Designation and Address of the Nodal Person in the :
Organization
1.4* Contact No. of the Nodal Person
:
1.5* Date of establishment of the Organization
:
2. Registration Details
:
2.1* Registration Details (Act under which registered with registration number and date) (enclose copies of Certificates and Bye laws/ Constitution)
Whether, it is:
a) An Organization registered under the Societies
Registration Act, 1860 (Act XXI of 1860);
b) A public trust registered under any law for the time
being in force;
c) Indian Red Cross Society or its branches; d) Company registered under Section 8 of the
Companies Act, 2013;
2.2* PAN number of the Organization
:
2.3* Registration number under section 12AA of Income Tax Act, :
1961 (attach a copy of the certificate).
2.4 Registration number under section 80G of the Income Tax Act, :
1961 (attach a copy of the certificate).
2.5 FCRA Registration Certificate No. (attach a copy of the :
certificate).
2.6 Registration No. of the Organization with NITI Aayog NGO :
Darpan Portal (attach a copy of the certificate).
3. Assets (Movable/ Immovable property)
3.1* Building (in sq. ft):
:
i. If the organization owns the building, attach photo of the building, photocopy of the land record and plan of the building.
ii. If rented, attach photocopy of the lease agreement with
the Owner of the building and photo of the building.
iii. Is the building accessible to the PwDs ?
:
33.2 Vehicle:
:
i. No. of vehicles owned by the organisation (specify
make and model).
ii. No. of vehicles plying on lease in the Organisation
(specify make and model).
3.3* Equipment:
:
A statement detailing name, type and number of equipment
owned by the Organization.
3.4 If any other (please attach separate sheet)
:
4. Beneficiaries
4.1* Category-wise number of PwDs being benefittedby the :
Organization.
:
4.2* A statement detailing PwD beneficiaries of the Organization in a separate sheet in tabular form with the following information: Name, Parent's Name, Contact No., Address, DoB, Type of disability, Percentage of disability, UDID No., Aadhar No., Resident/ Non-Resident.
5. Human Resources
5.1* Bio data of all governing body members/ trustees with their :
contact details, Aadhar No. and photograph.
:
5.2* A statement detailing all professionals employed in the Organization in a separate sheet in tabular form with the following information: Name, Address, Contact No., DoB, Aadhar No., Professional expertise, registration number with the Rehabilitation Council of India or any other appropriate body, DoJ in the organization, Full/ Part time (Enclose copies substantiating above information).
:
5.3* A statement detailing persons employed in the Organization in a separate sheet in tabular form with the following information: Name, Address, DoB, Aadhar No., Qualification, Assigned duty, DoJ in the organization, Full/ Part time.
6. Organization
:
6.1* Nature of work by the Organization: (Please indicate precisely whether it is: educational/vocational/ training institution/ workshop for the blind, the deaf and dumb, the orthopedically handicapped mentally retarded persons etc.).
6.2* Operational reach of the Organization (whether it is working in :
a National/ State/ District level).
6.3 Brief history of the organization, its objectives and activities. :
:
6.4* A statement indicating details of assistance/ Grant-in-Aid (in terms of year, purpose, amount) received during the last five years from the Central/ State Government, PSUs, Local Bodies or any other Quasi-Government institutions.
4:
6.5* Audited statement and details of grant received (if any) duly audited by a Chartered Accountant or a Government Auditor for the last three years.
6.6* Income Tax Returns of the organization for last three years :
6.7* Annual Reports of the organization for the last three years :
6.8 List of additional papers, if any
:
6.9 List of additional information, if any
:
• Fields marked with astreik (*) are mandatory.
DECLARATION
I have read the provisions of the Rights of Persons with Disabilities Act, 2016 and Rules thereunder and undertake to abide by all the conditions of the Act/ Rules.
My Organization will be responsible to provide such facilities and maintain such standard as may be prescribed by the State Government from time to time. The Competent Authority declared by the State Government for the purpose may de- recognize and cancel certificate of registration of my institution in case of any information submitted herein are found to be incorrector deviation of provisions of the Act and Rules thereunder.
SIGNATURE OF THE APPLICANT
Name:
Date:
(SEAL OF THE ORGANISATION)5
FORM - III
[See rule 10(1)]
APPLICATION FOR RENEWAL OF REGISTRATION OF INSTITUTION WORKING IN THE
FIELD OF DISABILITIES
(To be submitted in duplicate)
1. Basic Information
1.1* Name of the Applicant Organization : 1.2* Complete Postal Address with Contact No. and E- Mail Id : : 1.3* Name, Designation and Address of the Nodal Person in the
Organization.
1.4* Contact No. of the Nodal Person 1.5* Date of establishment of the Organization
: :
2. Registration Details
:
2.1* Registration No. under Rule-8 of ORPwD Rules, 2018 and date of expiry (Please enclose original Certificate of Registration)
2.2 Registration number under section 80G of the Income Tax :
Act, 1961 (attach a copy of the certificate).
2.3 FCRA Registration Certificate No. (attach a copy of the :
certificate).
:
2.4* Registration number of the Organization with NITI Aayog NGO Darpan Portal (attach a copy of the certificate).
3. Assets (Movable/ Immovable property)
3.1* Building (in sq. ft):
:
i. If the organization owns the building, attach photo of the building, photocopy of the land record and plan of the building.
ii. If rented, attach photocopy of the lease agreement with the
:
Owner of the building and photo of the building.
iii. Is the building accessible to the PwDs ?
3.2 Vehicle:
i. No. of vehicles owned by the Organisation (specify make :
and model)
ii. No. of vehicles plying on lease in the Organisation (specify
make and model)
3.3* a) Equipment:
:
A statement detailing name, type and number of equipment owned by the Organization.
3.4 b) If any other (please specify)
4. Beneficiaries
4.1* Category-wise number of beneficiaries being served by the :
Organization
:
4.2* A statement detailing PwD beneficiaries of the Organization in a separate sheet in tabular form with the following information: Name, Parent's Name, Contact No., Address, DoB, Type of disability, Percentage of disability, UDID No., Aadhar No., Resident/ Non-Resident.
5. Human Resources
5.1* Bio data of all governing body members/ trustees with their :
contact details and photo
:
5.2* A statement detailing all professionals employed in the Organization in a separate sheet in tabular form with the6 following information: Name, Address, Contact No., DoB, Aadhar No., Professional expertise, registration number with the Rehabilitation Council of India or any other appropriate body, DoJ in the organization, Full/ Part time (Enclose copies substantiating above information).
:
5.3* A statement detailing persons employed in the Organization in a separate sheet in tabular form with the following information: Name, Address, DoB, Aadhar No., Qualification, Duty assigned, DoJ in the organization, Full/ Part time.
6. Organization
:
6.1* A statement indicating details of assistance/ Grant-in-Aid (in terms of year, purpose, amount) received during the last five years from the Central/ State Government, PSUs, Local Bodies or any other Quasi-Government institutions.
:
6.2* Audited statement and details of grant received (if any) duly audited by a Chartered Accountant or a Government Auditor for the last five years.
6.3* Income Tax Return of the organization for last five years : 6.4* Annual Reports of the organization for the last three years : 6.5 If any other information, please specify and attach supporting
document.
• Fields marked with astreik (*) are mandatory.
DECLARATION
I have read the provisions of the Rights of Persons with Disabilities Act, 2016 and Rules thereunder and undertake to abide by all the conditions of the Act/ Rules.
My Organization will be responsible to provide such facilities and maintain such standard as may be prescribed by the State Government from time to time. The Competent Authority declared by the State Government for the purpose may de- recognize and cancel certificate of registration of my institution in case of any information submitted herein are found to be incorrect or deviation of provisions of the Act and Rules thereunder.
SIGNATURE OF THE APPLICANT
Name:
Date:
(SEAL OF THE ORGANISATION)
By Order of the Governor
NITEN CHANDRA
Principal Secretary to Government
Printed and published by the Director, Printing, Stationery and Publication, Odisha, Cuttack-10 Ex. Gaz. 1374-173+10