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Template I (B)

Profile of the Implementing Agency (I.A)

I Institutional Structure/Registration Details

B.1 Legal Status Central/State Government Institution

Society (Under Societies Registration Act, 1!"#

Co$o%erative Society (Under a%%ro%riate statue#

Registered as &rust'ro%rietary irm/%artners)i%

Registered under Com%anies Act, 1*+!

- 'rivate Limited Com%any

- 'ulic Limited Com%any

- Com%any under Section

- 'roducer Com%any under Section +1C

-t)ers (S%eciy#

B. ate o

Incor%oration/Registration

Attac) Certiicate o Incor%oration

B.0 Registered Address

B. -ice Address/Locations

B.+ Ailiated to 23IC 4es/5o

I yes, %rovide Certiied 5o.6666666666666666666 

3alidity o Certiicate666666666666666666666 

II Goernance Structure

B.! !omposition of the"#ecutie

Boar$/Trustees/Goernin

g Bo$y/%anaging

!ommittee

&ame of the%em'er

Designation

Bacgroun$/Profile

!ontact&um'er

"mail

Bacgroun$ of %em'ers

 5ot Availale

B.7 In case* IA is registere$

un$er !ompanies Act*proi$e sharehol$ing

pattern

&ame of the mem'er Bacgroun$/

Profile

Sharehol$ing (+)

 5ot Availale

III ,perational Profile

B. 8a9or -9ectives$ 3ision,

8ission, Goal o t)eorganisation

B.* :)at are ocus areas o

o%erational

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B.1" 'rovide ;ey %ro9ects/activities

 eing underta;en y t)e IA$

Brie descri%tion including t)e

 %ro9ect sco%e, si<e and duration

(8ention s%eciic e=%erience in

t)e area/sector o t)e %ro%osed

 %ro9ect#B.11 8ention ;ey clients/donors

associated >it) or %ro9ect

im%lementation along >it)

details on t)e nature o

association

B.1 8ention ;ey

 %artners)i%s/alliances (i any#

I3 %anagement Profile

B.10 Bac;ground o ;ey 'ersonal('roessional and ot)ers# >it)

 rie %roile o t)e senior

management %ersonal

3 -inancial Position

B.1 2ey inancials o t)e

organisation (%rovide co%y o

t)e audited inancial statements

or last 0 years#

?i=ed Assets

Current Assets

Current Liailities

Revenue trend or

last 0 years

'roit/Loss or t)e

last 0 years

IS@C availed in

case o

23IC/23IB Inst.

  4es 5o

Amount o IS@C

availed during last

0 years

Any ot)er 

3I Ban Account Details

B.1+ 5ame o t)e Ban;  

B.1! Branc) 5ame

B.17 Ban; Account 5umer  

I?SC Code

3II !ontact Details

B.1 5ame o Contact 'erson

B.1* esignation o Contact 'erson

B." Corres%ondence Address

B.1 Contact 5umer  B. @$mail Address