[cr-india] Application form... (DRAFT ONLY)

[Frederick Noronha]

APPLICATION FORM FOR GRANT OF PERMISSION FOR SETTING UP COMMUNITY
RADIO STATION (FM)
To be submitted in quadruplicate
D R A F T * Unofficial release

The Secretary,
Ministry of Information & Broadcasting
'A' Wing, Shastri Bhavan
New Delhi 110001

Sir,

I hereby submit the following details in support of the eligibility as
prescribed in the guidelines for grant of permission for setting up
community radio station (FM) in India.

1. Name of the institution/organisation:
2. Location
3. Mailing address for communication: Pin: Tel No: Email: Fax:
4. Local address, in any (of Delhi):
5. Name of the head of the institution/organisation:
6. Name, designation and address of the authorised signatory
responsible for complying with the terms and conditions of the Grant
of Permission Agreement (GOPA) (details to be furnished as per
Annexure-II)
7. Details of the organization and members of the governing body
(please furnish details of members along with bio-data of each member
as per Annexure II)
8. Furnish the followig details in case of:

(A) EDUCATIONAL INSTITUTIONS
(i) Whether the educational institution is private/government aided:
(ii) Whether recognised by
(iii) (a) Central Government (b) State Government
Please furnish details along with documentary proof.
(iv) Give a profile of the institution
(vii) Details of the community/area proposed to be served? (Enclose an
area map indicating the entire area of service to be covered by the
Community Radio)

(B) AGRICULTURAL UNIVERSITY/ICAR INSTITUTION/KRISHI VIGYAN KENDRA
(i) Whether the institution/organisation is private/government aided:
(ii) Whether recognised by
(iii) Central government (b) State government
(Please furnish details along with documentary proof)
(iv) Give a profile of the institution
(vii) Details of the community/area proposed to be served?  (Enclose
an area map indicating the area of service to be covered by the
community radio)

(C) NON-PROFIT ORGANISATIONS, VOLUNTARY ORGANISATIONS, NGOs ETC:
(i) Whether registered under Societies Act (please furnish details and
eclose attested photocopy of the registration certificate)
(ii) Whether completed three years of registration at the time of application
(iii) Enclose a copy of the Memorandum of (sic) Articles of Association:
(iv) Enclose certified copies of the balance sheet for the last three
years of the organisation/NGO/civil society organisation
(v) Whether received grant from the Central Government/Sate
Government/multilateral agencies? (If yes, please give details with
supporting documents)
(vi) Give a profile o fthe organisation including past achievements,
community-based projects undertaken
(vii) Details of the community/area proposed to be served? (Enclose an
area map indicating the entire area of services to be covered by the
community radio)
(viii) Objectives sought to be achieved by setting up the CRS?

OTHER GENERAL INFORMATION TO BE PROVIDED BY ALL APPLICANTS

9. State the (i) power of the FM radio transmitter: (Upto 100 watt ERP
is generally permitted. In exceptional cases upto 250 watt ERP could
be considerd subject to the conditions laid down in the guidelines)
(ii) Height of the tower (max 30 meter and min 15 meter above ground
level permitted)

10. Location of the FM transmitter and antenna: (In the case of
educational institutions, the FM transmitter and antenna should be
located within the premises of educational institution. In all other
cases, the FM transmitter and antenna should be located within the
geographical area of the community to be served. Please indicate th
ename of the villgae/town/area etc where transmitter and antenna is to
be located and the entire area of service to be covered by the
community radio along with a map.) Mobile FM transmitter and antenna
is not permitted.

11. Nature/types of programmes to be broadcast
12. Languag(s) in which programme is to be produced/broadcast:
13. Source of conent (own/acquired)
14. Details of sources for funding for:
a. Setting up infrastructure
b. Maintenance
c. Programme production

15. Foreign aid, if any: (Foreign aid permitted only from multilateral
agencies. Please attach a copy of the FCRA clearance.)

16. Details of the processing fee: Attached demand draft no........
dated ... for Rs 2500 towards processing fee drawn on (name of the
bank, branch) in favour of Pay & Accounts Officer, Ministry of
Information & Broadcasting, New Delhi. (Please note that the DD must
be payable at Delhi/New Delhi only).

{Please note, annexures not included}
{Please note, this is ONLY A DRAFT, not officially release. Don't use
this form to make your application!}