ANNEXURE –‘A’

INDIAN RED CROSS SOCIETY

HARYANA STATE BRANCH

Red Cross Award Application Performa for President, District Red Cross Society……………

S.N. Particulars Description

a) Name of President
b) District
c) Applied for the Award
d) Working as District President Since
e) Presently Incumbent or Not
f) Previous Red Cross Award received
g) Red Cross Activities performed during the year 2018-19:
(i) Membership Collection (in figures) i.e.
(Red Cross, HWS and St. John)
(ii) Donations Collected (in figures)
(Red Cross, HWS and St. John)
(iii) District Level Camps Organised
(YRC, JRC, St. John Brigade Officers and St. John Ambulance
Competition)
(iv) Drug De-Addiction Camp organised or any other awareness
camp organised
(v) Artificial Aids & Appliances Assessment & Distribution camp
organised in association with ALIMCO: -
a. Assessment Camps (Date and Total Registration)
b. Distribution Camps (Date, Total Distribution with cost)
(vi) Aids & Appliances manufactured & distributed through
rehabilitation centres: - (Where the centres are established)
a. Total Equipments Manufactured during the year
b. Equipment Distributed (Total Distribution with cost)
(vii) Voluntary Blood Donation Camps organised and number of
units collected. (if figures)
(viii) Funds Collected through CSR (Amount in Figures) and where
utilized
(ix) Funds Collected through Punchayat Fund (in figures)
(x) Funds Received / Recovered through DITS under HARIS (In
figures)
(xi) Mobilization of funds through any other sources.
(x) Initiatives for funds raising(Brief Detail)
h) St. John Ambulance Trainings:-
a. First Aid Training
b. Home Nursing Training
c. Number of Brigade formation
d. Lecturer Enrolled
e. St. John Post Establish during the year
i) Any other Red Cross activity
(Please attach separate sheet for providing more information)
* Please attach separate sheet for providing more information about activities and achievements.
 ANNEXURE –‘B’
INDIAN RED CROSS SOCIETY
HARYANA STATE BRANCH
Red Cross Award Performa for the Red Cross District Red Cross Secretaries/Assistant
Secretaries/D.T.O. & Other Staff Members: -
S.N. Particulars Description
a) Name and Designation of Employee
b) District
c) Applied for the Award
d) Working with DRCS Since
e) Presently Incumbent or Not
f) Awards Received: - (Attach separate sheet for detail)
1. District Level Awards
2. State Level Awards (Received from Red Cross and State
Govt)
3. National Level Awards (Received from Red Cross
and Govt. of India)
g) Red Cross Activities performed during the year 2018-19:
(Attach separate sheet for detail)
(i) Membership Collection (in figures) i.e. Red Cross:………...
(Red Cross, HWS and St. John) HWS:……………St. John…………
(ii) Donations Collected (in figures) Red Cross:………
(Red Cross, HWS and St. John) HWS:..……… St. John……………
(iii) District Level Camps Organised
(YRC, JRC, St. John Brigade Officers and St. John
Ambulance Competition)
(iv) Drug De-Addiction Camp organised or any other
awareness programme organised i.e. Rallies,
conferences, seminars, health awareness camps,
blood donation camps, Health Check up camps etc.
(v) Artificial Aids & Appliances Assessment &
Distribution camp organised in association with
ALIMCO: -
a. Assessment Camps (Date and Total Registration)
b. Distribution Camps (Date, Total Distribution with
cost)
(vi) Aids & Appliances manufactured & distributed
through rehabilitation centres: - (Where the centres
are established)
a. Total No. of Equipments manufactured during the
year
Contd…2
 …2…

b. Equipment Distributed (Total Distribution

with cost)
(vii) Voluntary Blood Donation Camps organised and
number of units collected. (if figures)
(viii) Funds Collected through CSR (Amount in
Figures) and where utilized
(ix) Funds Collected through Punchayat Fund (in
figures)
(x) Funds Received / Recovered through DITS
under HARIS (In figures)
(xi) Mobilization of funds through any other sources.
(x) Initiatives for fund mobilization (Brief Detail)
h) St. John Ambulance Trainings:-
a. First Aid Training
b. Home Nursing Training
c. Number of Brigade formation
d. Lecturer Enrolled
e. St. John Post Established during the year
i) Any other Red Cross activity
(Please attach separate sheet for providing more
information)
* Please attach separate sheet for providing more information about activities and achievements.
** Please filled up all the columns, no column left blank.
 ANNEXURE –‘C’
INDIAN RED CROSS SOCIETY
HARYANA STATE BRANCH
Red Cross Award for Red Cross Volunteers/Social Workers/Associated NGOs/ Institutions
S.N. Particulars Description
a) Name and Volunteer / NGOs/ Institution
b) Address
c) Applied for the Award
d) Working with DRCS Since
e) Awards Received: - (Attach separate sheet for detail)
1. District Level Awards
2. State Level Awards (Received from Red Cross and State
Govt)
3. National Level Awards (Received from Red Cross
and Govt. of India)
f) Red Cross Activities performed during the year 2018-19:
(Attach separate sheet for detail)
(i) Membership Collection (in figures) i.e. Red Cross:………...
(Red Cross, HWS and St. John) HWS:……………St. John…………
(ii) Donations Collected (in figures) Red Cross:………
(Red Cross, HWS and St. John) HWS:..……… St. John……………
(iii) Drug De-Addiction Camp organised or any other
awareness programme organised i.e. Rallies,
conferences, seminars, health awareness camps,
health check up camps.
(Provide brief detail on separate sheet)
(iv) Voluntary Blood Donation Camps organised and
number of units collected. (if figures)
(viii) CSR Collection & Donation (Amount in Figures)
(xi) Mobilization of funds through any other sources.
(x) Initiatives for fund mobilization (Brief Detail)
h) Any other Red Cross activity
(Please attach separate sheet for providing more
information)
* Please attach separate sheet for providing more information about activities and achievements.
** Please filled up all the columns, no column left blank.