JHARKHAND BIODIVERSITY BOARD
APPLICATION FORM

Please mark the appropriate box:
Area of Participation	Applying as	
	Educational Institution	Research Institution	NGO	
As mentioned in Expression of Interest				

Please mention the District(s) you are interested to work in:

ORGANISATION PROFILE
1	BASIC DETAILS	
	Name of the Organization		
	Address for correspondence		
	Pin Code		
	Ph. & Fax No (with STD code)		
	E-mail		
	Name & Designation of the Chief Functionary		
	Name and address of other Office bearers	
	
	Address of the field units and name of the person looking after the overall functioning of the respective units	

2	REGISTRATION DETAILS	
	Registration No		
	Act under which the organization has been registered		
	Date of Registration		
3	ACCOUNTING DETAILS	
	FCRA no.(if available)		
	PAN No. 		
	Banking details: (Account holder's name/Account No. name/Address of bank)		
	Provide years of which the accounts have been audited		
4	STAFF DETAILS (please mention only the name of regularly working staff who are getting their remuneration/salary from the organisation)	
	Number and names of Full time staff and their qualifications		
	Number and names of Part time staff (including volunteers) and their qualification		
	Number and names of Technical Staff (from bio-science background) and their qualifications		
	Separate sheets may be enclosed to provide the details regarding staff.	
5	WORK EXPERIENCE DETAILS	
a.	Does the Educational/ Research Institution/ NGO have experience of working with Community Based Organisations? Provide details in separate sheet if any:	
		
b.	Details of Educational/ Research Institution/ NGO presence & networking in the district/s: 
(Provide details in separate sheet)	
		
c.	Has Educational/ Research Institution/ NGO been evaluated by any independent agency? If yes, attach report:	
		
d.	Has a Government Department/ Ministry ever blacklisted or imposed funding restrictions on the Educational/ Research Institution/ NGO? (Please provide details, if yes) :	
		
e.	Brief resume of work done in the concerned areas (biodiversity related) by Educational/Research Institution/ NGO (year wise) in the last 10 years:	

Attachments to be furnished along with the application (without which the application will be rejected):

1.	Registration Certificate of the organization. 
2.	Bye laws and Memorandum of Association of the organization. 
3.	Financial Report for the F.Y. 2016-17.
4.	Audit Report for till F.Y. 2015-16 (last ten years).
5.	Annual report for each of the previous last 3 years.
6.	Latest list of Executive members along with their address, e-mail and phone numbers. 
7.	Details of technical personnel having expertise in Biological Sciences/Agriculture/Forestry available with the organization along with their designation, qualification and experience. 
8.	List of Fixed assets (land & building) as per Audited balance sheet along with Audited report of last three years.
9.	Any relevant information as required by the Board.