Declaration Template: Indicator 1.

1
Data required for Q3:

Total Number of Wards in the ULB:

*should match with the number of wards on SBM Portal

Total Number of Wards in the ULB where 100% Segregated

D2D Collection of Waste takes place:
Whether the waste is segregated into 3 types i.e. (wet, dry,
sanitary and domestic hazardous) and maintained till Yes  No 
dedicated processing facility for the stream?

Is the D2D collection of segregated waste from the gates(as

defined in the toolkit) in the wards outsourced to a
Yes  No 
vendor/third party? For some wards 
Is the waste from Homes Quarantined under COVID-19
collected separately as per MoHUA guidelines in the ULB? Yes  No 
Daily  Alternate Days 
What is the frequency of dry waste collection within the ULB?
Twice a week  Once a Week. 

Is real-time segregated waste collection details maintained

Yes  No 
by the ULB for every vehicle and vendor? Under Implementation 
Documents to be submitted by the ULB for evaluation:

If D2D collection of segregated waste from households is

outsourced, then attach the latest and valid agreement/MoU Attached  Not Available. 
signed between the ULB and third party vendor.
*date & signatures of both the parties are compulsory for the document to be considered.
Under Renewal process. 
If real-time segregated waste collection details are
maintained by the ULB, then attach the document showing Attached  Not Available. 
the real time tracking and monitoring of the vehicles in Q3
(along with screenshots of the tracking page.

I hereby declare that the data/information provided above table, on Swachhatam portal and in the attached
documents is true to the best of my knowledge and reflects the status of the progress on ground in the ULB.

Signature & Stamp of the Nodal Officer/Head of the ULB

Name: ULB Code:
Designation: ULB Name:
Date:

Prepared by