Annual lnspection of orphanages and other charitable homes recognized by the orphanage controt Board

2012-13

1. 2.

Name of district

Name of Panchayath/Municipalrty/ Corporation

Name and full aildress of the!nstitution with land phone numbers and mobile No. of the correspondent

3. 4.

Registration number with dale and validity period. Category of inmates sanctioned (mentioned as per the Reg: certificate)

trorphaffi

orphans and non-orphans

Orphans
Boys

Non orphan

Giris

Boy-s I Girls

5. 6. 7. u. 9 u.
11,

Category of inmates now residing

$anciioned number of inmates

Present strength of inmates
.No. of children attending education institution

Male: Male: Male: Male: Male: ..

Female Female Female

No. of inmates whose destitution cedificate have been obtained

Female

r\o. or rnmates having no destitution certifrcate lf ration permit is available, rnentron the sanction order and no. of sanctioned inmates for ration.

Female

t.

I i

lf yes mention whether it is domestic connection or Nondomesiic connection

available

vvnelner gas connectlon

is

Yes / No

_t

13.

No. of inmates who have been admitted from outside the state of Kerala.

Male.

Female

a)

Name of the state from which they have been brought Yes /No

14.

Whether sanitary certificate from thC medical officer have been obtained.

15.

a) lf yes number & date of sanitary certificate Whether grant have been sanctioned to the institution, if so mention the Govt. sanction order No. & Date
.

Yes 1No

a. b.

No. of inmates sanction grant

Male: Male:

Female Female

No. of inmates received the grant

lf the grant sanctioned the amount of grant received last with date

c.

16.

General verification

a. Accommodation b. Food

Sati sfa cto ryiN ot satisfactory

S

atisfactory/N of satisfactory
rylN ot sati sfactory

c. Medical facilities d. Education e. Rehabilitation

S ati sfa cto S S

atisfacto rylN ot s atisfactory atisfacto rylN ot satisfacto ry

17.

Name and address of the lnspecting Officer with phone number

18. 19.

Signature of the lnspecting Officer Signature of the correspondent authorized person from the lnstitution with designation and name

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