Beruflich Dokumente
Kultur Dokumente
This form should be completed for A New Project to be undertaken by EWB India
chapter/NGO/Society/Organization under CSR Program and submitted to EWB India.
The PAF received will be reviewed by a Technical Review Committee (TRC) looking at
the following parameters:
1. 1 Applicant Information
1.1.2 If answer to 1.1.1 is (b); has a chapter of EWB-INDIA agreed to accept and assist in
this program?
Yes No
If Yes,
Name of Chapter(s) :
Contact person :
E-mail :
Phone/Mobile :
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
________________________________________________________
Contact Person :
Address :
Phone& Mobile :
E-mail :
Website (if any) :
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
Sanitation
Water Supply Toilet/Latrine
Source Development Gray water system
Water Storage Black water system
Water Distribution Structures
Water Treatment Building
Water Pump Drainage
Water filtering system Dams
Energy Others
Fuel Supply Education
Electricity Information Systems
Renewable Energy Computers and related work
Solar Any Other area - Please
Wind specify.........................................
Biomass ............................................
Conventional Energy
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
2.1.5 Project Goals: Elaborate on the goals of this project. Please answer the
questions below ONLY if they relate to the project briefly:
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
What are the impacts anticipated at the completion of this project (Health,
economic, environmental, social and cultural effects)? (Approximately 100
words)
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
___________________________________________________________
b. Will a committee be established?
___________________________________________________________
c. Who will manage and be responsible for the maintenance & repairs?
___________________________________________________________
a. Will the proposed project be freely accessible to all persons in the local
area, or will it be restricted for use by certain groups?
___________________________________________________________
b. Will a fee structure be involved?
___________________________________________________________
c. Who will decide on the amount of the fees, and who will collect the
fees?
___________________________________________________________
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
3.1 Additional Information: Please add any other information you think is
relevant to this Program/project. This can include Photographs during site visit
etc.
Signature of Applicant:
Name of Applicant:
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
PROJECT FINANCIALS
I REVENUES AMOUNT
A Funds raised to date, please list sources below, adding rows
as needed
Grants Received
(i)
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(ii)
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(iii)
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(iv)
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(v)
B In-kind support
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org
(Regd No. 1379/2005 under the Andhra Pradesh Societies Registration Act, 2001)
6-3-668/77 &78, Durga Nagar Colony, Punjagutta, Hyderabad 500082. Tel: 040-23410945, Page 1
Email: ewbindia@ewb-india.org Website : www.ewb-ind.org