(To be routed through the State Government/ Union Territory Administration)



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Matching Scheme of Assistance forwards purchase of storage materials, reading room furniture and library equipment like card cabinet, fire extinguisher etc., including copier Application for grant under the matching Scheme of Assistance towards purchase of storage materials, reading room furniture and library equipment like card cabinet, fire extinguisher., including copier From : (To be routed through the State Government/ Union Territory Administration) To The Director Raja Rammohun Roy Library Foundation Block-DD-34, Sector-1, Salt Lake Kolkata 700 064. Subject : Assistance forwards purchase of storage materials, reading room furniture and library equipment like card cabinet, fire extinguisher etc., including copier Sir, I submit herewith an application vide Annexure-1 for a grant under the Matching Scheme of Assistance forwards purchase of storage materials, reading room furniture and library equipment like card cabinet, fire extinguisher etc., and I undertake to abide by them. On behalf of the management. I futher agree to the following conditions: a) All the assets acquired wholly or substantially out of the RRRLF s grant shall not be encumbered or disposed of or utilized for purposes other than that for which grant is given. Should the library cease to exist at any time. Such properties shall revert to the RRRLF. b) The accounts of the project shall be properly and specifically reflected in the final accounts of the library. This shall also be open the test check by the RRRLF or the State Government /U.T. Administration. c) The organization undertakes to meet the balance of the estimated expenditure of the project/proposal. d) The present application from duly filled in is enclosed together with the required documents.

e) In case of failure to submit requisite documents in utilizing the grant within the stipulated period, the library shall be liable to refund the entire amount of the grant. Yours faithfully; Place : Date : Signature of the applicant With designation and office seal Annuexure-1 (All the columns are to be filled up properly by the applicant in English or Hindi (official language) in Capital letters) 1. A Name of the institution /organization sponsoring the project: 1. B postal address of the applicant: i. Name of the Street/Row/Lance with premises no. if any ii. Village/Town, Via iii. Post Office iv. District v. State vi. Name of Nearest Railway Station vii. pin code No. viii. STD Code No., Telephone No. (Route direction to reach the organization to be attached in separate sheet) 2. Nature of the institution/organization (Tick the appropriate) Govt./Aided/Private/Sponsore d/run by Local Body or LLA or Notified area Authority/ on- Govt.

3. (a) If Government, mentioned the Head of Department and Head of Office (b) If aided, whether it is a registered body. (If so, please quote the Society Registration No. and date and attach Xerox copy of Society Registration Certificate): 4. anaging Committee Names and address of the members Separate sheet be attached) 5. Particulars of staff with designation: 6. Source of income Grant from Govts. (Central and State), donation from public, Subscription from public, subscription from members etc.: 7. Average monthly expenditure 8. Average No. of readers and borrowers per month 9. Total no. of books and periodicals: (a) Books (b) Periodicals 10 Stock of Almirah and Racks: (a) No. of Almirah (ii) No. of Racks 11. Whether any grant is received from any other source for the same purpose, if so, give particular: 12. Particulars of furniture required to be purchased: (i) Type of Almirah/Rack/Cupboard (Steel or wooden) (ii) Size of Almirah /Rack/Cupboard (length, breath, height and no.of shelves) (iii) `Estimated cost (Attach catalogue/quotation from standard firm/supplier): (iv) Assistance sought for:

(Maximum assistance will be limited to provision at Clause 4 of the Rules & Regulations) (v) Balance amount, if any, (the source from which balance amount will be incurred to be specifically stated.): 13. Whether any grant is received from RRRLF under this scheme. If yes, sanction letter be mentioned: Yes/No 14. Declaration On behalf of the institution /organization I solemnly declare that the particular furnished above are true. I certify that I have read the rules and regulations of the scheme and I undertake to abide by them. The Cheque may be drawn in favour of List of Enclosures: (i) Constitution/Memorandum of Association of the organization (ii) Copy of the Society Registration Certificate (iii) Latest available Annual Report (iv) Latest available Audited Accounts (v) Item-wise details of estimated expenditure (vi) Detail description of the project with justification Place: Date: Signature of the applicant with designation and office seal

15. Recommendation This is to certify that the project/proposal is useful for improvement of library services in the State/U.T. and deserves assistance from of the RRRLF, The amount of assistance recommended Rs... (Rupees.) only from the matching fund which have been approved in State library Committee/State Library Planning Committee Meeting held on Place: Date : Signature.. Name and designation of the Convener, SLC/SLPC Office Seal