APPLICATION FORM FOR EMPANELMENT OF ORGANISATIONS

APPLICATION FORM FOR EMPANELMENT OF ORGANISATIONS
01 Name of the Organisation (BLOCK LETTERS)
02 Brief Portfolio of the Organisation
(Attach as Annexure- II)
03 Registration No. and Date
(Attach Photocopy in Annexure- III)
04 Official Address
05 Phone No.
06 Name of the Organisation Head
07 Mobile No. of the Organisation Head
08 Email ID ALTERNATE NO. (OPTIONAL)
09 PAN No. of the Organisation Head
(Attach Photocopy in Annexure- I)
10 GSTIN of the Organisation (OPTIONAL)
(Attach Photocopy in Annexure- II)
11 Date of Incorporation
(Attach Photocopy in Annexure- III)
12 Affiliation/ Accreditation/ Recognition of competent authority (If Any) (Attach Photocopy in Annexure-IV)
13 Details of the Available Infrastructure (if any) (Location, Training Facilities, Equipments, Establishment etc.)
(Attach in Annexure- V)
14 Whether the Organisation has a Panel of Skilled Trainers for various trades
15 If Yes, Please Provide –
1. For Category A Trades (High Skill) – Number of available trainers and Qualification of the Trainers
2. For any other trade – Number of Master Trainers
3. Number of Associate Trainers
4. Location of the Trainers – (District and Block)
(Attach in Annexure- VI)
16 Whether the Applicant has at least Two Years experience of providing Training/ Capacity Building
17 If Yes Please Provide –
1. Brief Description of Training/ Capacity Building Programmes undertaken in last Two Years along with supporting documents.
2. Work Order/ Letter from the Programme Coordinator.
3. Programme Completion Certificate (if any).
(Attach in Annexure- VII)
18 Whether the applicant has prior experience of working with Govt. Departments/ Organisations/ Cooperative Banks/ Cooperative Societies/ NGOs (Give Details)
19 If Yes Please Provide –
1. Brief Description of Training/ Capacity Building Programmes undertaken in last Two Years along with supporting documents.
2. Past and Present Empanelment as Vocational Skill Trainer (If Any)
3. Existing collaboration with recognised organisations (if any)
4. Work Order/ Letter from the organisations
5. Programme Completion Certificate (if any).
(Attach in Annexure- VIII)
20 Trades / Services for which the Organisation is Applying for Empanelment
21 Whether any Special/ Innovative Project or Capacity Building Programme taken up by the organisation (Give Details) (Attach in Annexure- IX)
22 Awards Received (If Any)
(Attach in Annexure- X)
23 Any other related Information
(Attach in Annexure- XI)
Declaration
1. We hereby declare that we have the capacity to arrange for/ providing Machineries, Equipments and Training Materials required for organising the training programmes as Standardised by ICMARD for the trades/ services we are applying for.
2. We are able to serve Trainersfor both short and long term Programmes in the Urban and Rural Areas in nearby Districts of West Bengal as selected by ICMARD along with all types of Machineries, Equipments and Training Material support as and when required.
3. We are capable of providing Marketing Support temporarily for the TargetGroups of Trainees for the Trades/ Services under supervision of ICMARD.

Check List

Annexure- I

LIST OF TRADES AND SERVICES (Attached)

Annexure- II

Brief Portfolio of the Organisation

Annexure- III

Copy of Registration Certificate, Copy of PAN Card and Adhaar Card of The Organisation Head, Copy of GSTIN, Date of Incorporation, Affiliation/ Accreditation/ Recognition of competent authority (If Any)

Annexure-IV
  1. Details of the Available Infrastructure (if any) (Location, Training Facilities, Equipments, Establishment etc.)
  2. For Category A Trades (High Skill) – Number of available trainers and Qualification of the Trainers 
  3. For any other trade – Number of Master Trainers
  4. Number of Associate Trainers
  5. Location of the Trainers – (District and Block)

Annexure-V
  1. Brief Description of Training/ Capacity Building Programmes undertaken in last Two Years along with supporting documents.
  2. Work Order/ Letter from the Programme Coordinator.
  3. Programme Completion Certificate (if any).
  4. Past and Present Empanelment as Vocational Skill Trainer (If Any)

Annexure –V

Photo Documentation (if any) of the activities (Optional)