FORM NO. V

[See Rule 9 Sub rule (v)]
FORM OF APPLICATION FOR RENEWAL OF CERTIFICATION

1. Name of the Welfare Institution/Organization
2. Full Address
3. Brief account of the achievements during last five years
4. Name and address of head of the Institution / Organization
5. Certificate No., date and date of expiry
6. Any other particulars

Place:
Date:

Signature of the Head of the Welfare Institution/Organizations

By Order of the Governor,

.......................................

Secretary to Government