EXTRAORDINARY

PUBLISHED BY AUTHORITY

No.1897, CUTTACK, TUESDAY, OCTOBER 9, 2018/ ASWINA 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.

2

FORM - 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 ?

:

:

3

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*

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 the

:

6

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