Channel Partner Data Sheet

NGOs, Community Based Organizations, Trust or Society or Co-operatives, MFIs or other organizations willing to avail financial assistance as channel Partner under Umbrella Programme on Natural resource Management (UPNRM) are required to furnish the following information about their organization:

1.            Name of Channel partner:

2.            Legal Status:
               

1. Whether Trust or Society  or Co-operatives, MFIs:
2. Trust Registration Number :
3. Society Registration Number :
4. Date of Registration __________________, Place________________

Note :  Please enclose copy of Registration Certificates and copy of Memorandum of Association / Trust Deed and, Bye Laws, Rules and Regulations.

3.            F.C.R.A. Registration Number : _____________
                Note: Please enclose xerox copy of certificate.

4.            i.             Registered Address of Head Office :
                                Area of Operation:
                ii.            Address of Sub-Branches/Centres:
                                Area of Operation:

5.            Other Details:

1. Name and designation of the Chief Functionary or contact person
2. Address for regular correspondence:
3. Telephone number (Office and Residence):
4. Grams :
5. Fax number :

6.            Members of Governing Board /Office bearers of Organization
                Please enclose list of office bearers in the following format.

Give details regarding full time availability of decision maker, flexibility, non rigidity, personal relation with leadership qualities and experience of the key Functionaries in rural development/ NRM related projects.
7. Quality of Governance: Details of last five board meetings

8.            Organisation Structure :
                Please indicate the authority structure/hierarchy (line of command), the departments, their responsibilities

9.            Brief resume of project in-charge including capability and experience:

10.          Staff Composition and Capacity:

                Please enclose information in the following format

                (a)  Honorary Staff

(b)    Paid Staff

11.          Assets ,Equipments and other infrastructure :
                Please enclose information in the following format
                (1)  Fixed assets (capital)

(2)  Equipment, Plant & Machineries

12.          Funding sources :
                Please state names and address of funding agencies.

13.          Projects handled in past/on-going:
                Please enclose information in the following format with emphasis on NRM projects

14.          Details of previous financial assistance availed in the form of loan (if any, give details of funding agency, purpose and quantum of assistance, amount outstanding)

15.          Largest project handled:
Comment briefly on the largest project (financially or man powerwise) handled so far, indicating specifically difficulties experienced in the project and any other salient experiences.

16.          Relationship with Government Departments:

1. Please indicate if you have implemented any Government programs in the past.  If yes, please indicate description of the project and amount involved.
2. Please describe what Government programs/schemes are being implemented presently by you.  Please state amount (Rs.) involved.
1.  

17.          Works/ Projects related to NRM  and Rural Livelihood sector: Please indicate the work done by the organization with special reference to the following activities:

1. soil and water conservation (including watershed programmes, dryland farming systems)

1. plantation and horticulture (tree based farming, wadi development, organic farming,)
2. forestry activities (Bamboo based farming, energy plantations, wasteland development rehabilitation and management /Community Forest management, pasture development biodiversity conservation)
3. farming systems management (including livestock and aquaculture resources)
4. climate change adaptation / Clean Development Mechanism (CDM)

18.          Rural Developmental Approach

1. Which area/disciplines you prefer to work in ?
2. How do you choose a village to work in?
3. How do you approach the village?
4. What programs do you introduce initially?

19.          Community institutions built in already implemented projects, methods and approach adopted in mobilizing and community building (give details of the institution built in and their present position)

20.          Financial Sustainability Aspects of Channel Partner (Gives details of financial position, long term funds available, sources of fund, etc)

21.          Please enclose copies of the following:

1. Audited financial statement for the past 3 years.
2. Annual reports for last 3 years.
3. Evaluation reports, if available.
4. Any other literature, if available.

Place :                                                                                           Signature
Date :
                                                                                                        Name and Designation:

                                                                                                        Name of the Organization: