CSR Proposal For Construction

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PROPOSAL FORMAT

GENERAL INSTRUCTIONS:

 Proposal should be accompanied by a covering letter on the letterhead of the


Organisation along with the financial estimate. The letter must be signed by an
authorised signatory of the proposing Organisation.
 Each page of the proposal and annexures should be stamped with Organisation seal and
countersigned by authorised signatory of the proposing Organisation
 All requisite permissions and approvals from appropriate authorities should be obtained
by the proposing Organisation and all statutory obligations and compliances met.
 For projects which require collaboration with a State Government/District
Administration, the proposal should preferably lead to a tripartite agreement between
the implementing Organisation, BPCL and the State Govt./District Administration.
 Proposals with incomplete documentation are liable to be rejected.
 BPCL reserves the right to accept/reject any proposal.
 In case the proposal gets approved, the Organisation would need to open a separate
bank account for the CSR project.
 If the Organization proposes to undertake large scale projects they must furnish proof
of having undertaken similar projects (Example Rs.5 crore and above), capability for
executing it successfully as well share profile of the team/staff.
 Project proposals which mention capability in gathering real time data, technological
intervention, project implementation support and impact assessment shall be given
preference.
Date: - DD/MM/YYYY

To : Bharat Petroleum Corporation Ltd

Subject: Proposal for..................................................................

1.0 About the Organisation/ संगठन के बारे में

(Organisational information- Historical overview/ past experience/ type of projects executed/


reach and presence within country & abroad/ staff strength/ success stories/accolades/awards
received if any. Also give website link if available).

2.0 Background/ प्रष्ठभूमम

(Give details of project background elaborating on the need of proposed project. Kindly
mention details of need assessment/appraisal carried out)

2.1 Thematic Area / मिषयगत क्षे त्र

(Mention the thrust area/s, Schedule VII item and Sustainable Development Goal (SDG)
under which the proposed project would be categorised)

Thrust Area Schedule VII item


Education (ii) promotion of education including special
education
Environment Sustainability (iv) Ensuring environmental sustainability
Health/Hygiene (i) promoting healthcare including preventive
healthcare and sanitation
Skill Development (ii) employment enhancing vocational skills and
livelihood enhancement projects
Community Development (x) Rural development projects/ Multiple categories
Others or More than one of
the above (Please Specify)
Please specify the SDG/s in addition to the above.

3.0 Proposal / पररयोजना प्रस्ताि

(Mention the proposal objectives. Explain the activities planned in order to achieve the specific
objective/s along with the time frame)

3.1 Methodology / काययप्रणाली

(Define the methodology for implementation of the program such as implementation schedule,
execution plan, selection criteria for specific beneficiaries etc.)

3.2 Target Group / लललललल लललल

(Mention Geographical area/location of the project and the profile of the beneficiaries - details
of Male/Female, minority or vulnerable group/others etc)

3.3 Team for the project / पररयोजना के मलए टीम

(Mention job profile & eligibility criteria for selection of staff/team members for the project
i.e. qualifications & experience, Roles & responsibilities, Organization structure etc.)

3.4 Monitoring Mechanism / मनगरानी तंत्र

(Mention the monitoring mechanism such as frequency of visits, plan for collection of data,
monitoring of activity timeline & frequency of submission of reports)

4.1 Outcomes/Result expected / अपेमक्षत पररणाम

(Mention the Quantitative & Qualitative outcomes expected from the project, outcomes should
be directly linked to proposed objectives; specific targets should be benchmarked. It is
recommended to use frameworks such as project matrix, verifiable indicators, data analysis.)

4.2 Execution Plan / मनष्पादन योजना

(Gantt chart with time line against activities may be given in tabular/other form)
4.3 Impact Assessment/ प्रभाि का आकलन

(Mention the plan to measure the impact of planned interventions of this project as defined in
the scope of work)

5.1 Financial Implications/ मित्तीय मनमितार्य

(Format given below is indicative. Based on the nature of the project, kindly use appropriate
format)

- Breakup for each line item should be given. Separate annexure to be provided if needed
- Any procurement items has to be supported with documents proving competitive rate
in the market.
- List down items covered under Administrative expenses.

Total Total
Per Number Budget for Budget for
unit of Units 1 ___Months/Years Remarks
Sr. cost (B) month/year (D=CX No. Of (Justification of
No Details (A) (C=AXB) Months/Years) cost element)
1

Sub Total (I)

Sub Total (II)

2
3

SUB TOTAL (III)

IV = TOTAL Of (I+II+III)

V = ADMINISTRATIVE
COST

GRAND TOTAL

Cost Per Beneficiary

5.2 Tentative payment schedule/ अं तररम भुगतान अनुसूची

(Link payment schedule with project deliverables and timeline. It will be reviewed by BPCL
and the final payment schedule might differ significantly as per nature of the project & BPCL
guidelines. For final payment, 10% of the total budget will be kept on hold until the submission
of the project completion report and audited fund utilisation certificate)

Sr. Description % of Total Amount Deliverables to be achieved


No. Project in Rs
Budget
1 1st Payment
2 2nd Payment
3 3rd Payment
4 4th payment after
completion
report of project
Grand Total (In words
______________________________
Only)

6.0 Sustainability Plan/ स्थर्रता योजना: -

(Provide an action plan giving details of how the project will be sustainable after exit of BPCL
& the implementing partner. This must include maintenance and ownership of assets where
applicable)

7.0 Conclusion/ मनष्कषय -

8.0 Enclosures / संलग्नक –

1. Form A :- Attached (Yes/No)


2. Form B :- To be filled only for infrastructure project only. Attached (Yes/No)
3. Form C :- Attached (Yes/No)
4. Form D :- Attached (Yes/No)
5. Form E :- Attached (Yes/No)
6. Form F :- Attached (Yes/No)

Kindly ensure the Organisation Seal/Stamp & Sign on each page.


Form A

CHECKLIST FOR SUBMISSION OF DOCUMENTS

Sr. Attached
Description of documents Remark
No. (Yes / No)

1* Trust deed

Certificate of incorporation/
2*
Registration certificate

3* CSR 1 Registration certificate

4* Form 12 A

5* Form 80 G

6 35 AC registration if any

7* PAN card

Last 3 financial years audited


8*
statements & ITR proof

Detailed proposal as per format


9*
given

10 FCRA approval

TDS exemption certificate if


11
applicable
GST Registration certificate if
12
applicable

2 Reference letters of past or


13
present supporters for CSR project

*Sr. Nos. are mandatory documents

Additional Information in respect of Audited Accounts as mentioned in Serial No. 7 of


Form-A of the Proposal Format for submission of CSR Proposals.
1. Please give the sources of income for each of the last 3 Financial Years for which audited
accounts have been submitted with the application.
(in Rs.)
Sr. Sources of Funds FY (……….) FY (……….) FY (……….)
No.
1
2
3
4
5
Total

2. Provide details of income, expenditure, assets and liabilities during the last 3 Financial
Years for which audited accounts are being submitted along with the application.
Total Income:
(in Rs.)
FY (……….) FY (……….) FY (……….) Major Reasons Major Reasons
for variation for variation
1 2 3 4 (1-2) 5 (2-3)

Total Expenditure:
(in Rs.)
FY (……….) FY (……….) FY (……….) Major Reasons Major Reasons
for variation for variation
1 2 3 4 (1-2) 5 (2-3)

Total Assets:
(in Rs.)
FY (……….) FY (……….) FY (……….) Major Reasons for Major Reasons
variation for variation
1 2 3 4 (1-2) 5 (2-3)

Total Liabilities:
(in Rs.)
FY (……….) FY (……….) FY (……….) Major Reasons Major Reasons
for variation for variation
1 2 3 4 (1-2) 5 (2-3)

3. Provide details of expenditures incurred during last 3 Financial Years other than
activities carried out by the NGO.
(in Rs.)

Sr. Year Amount of the Expenditure Description of the Expenditure


No. incurred other than the incurred other than the
activities of the NGO activities of the NGO
1 FY (……….)
2 FY (……….)
3 FY (……….)

Form B

CHECKLIST FOR INFRASTRUCTURE PROJECTS


Sr. Items Attached Remarks
No. (Yes/No)
A LAND RELATED
1 Land Ownership document
2 Property Card (Commercial/ Vastu/Wetland)
B ESTIMATES & APROVALS
1 Drawings- Site Plan, Building Plan, Elevation,
foundation / structural details. All drawings
needs to be signed & stamped by Licensed
Engineer/ Architect & Client.
License no. / Registration no. of Architect/
Engineer needs to be mentioned.
2 Drawings sanctioned by Govt. Authorities
3 Basis of Estimate -
For schedule items - Preferably to be made from
latest CPWD/ DSR /State Govt published rate
along with GST if any.
Brought out items- Preferably to be made from
Quotations of supplier / rate charts of
Manufacturers. Estimated needs to be vetted by
Govt. Engineer/ Retd. CPWD/ Retd State Govt.
Engineer
Estimate also to be signed & stamped by licensed
Engineer & Client

4 Stability certificate needs to be attached issued


by licensed engineer in case of expansion of
existing building.
C EXECUTION WORKS
1 Execution Plan (Mention in briefly, separate
annexure can be attached)
Form C

CHECKLIST FOR SUBMISSION OF PROPOSAL

S.
Points Details
N.

Address of registered office of the Organisation


1
(in India)

Any branches of the Organisation? Kindly


2
mention

Registered as a trust/society/ section 8 company


3
or Other

How long has the Organisation been in


4
existence in years?

Which is the Organisation’s geographical area


5
of work?
What is/are your Organisation's expertise
area/s?
a. Skill Development
b. Health & Hygiene
6
c. Education
d. Community Development
e. Environment Sustainability
f. Other/Multiple (Kindly mention)

7 Names of Board Members/Trustees and CEO.

Are any of the trustees/board members affiliated


8
to any political / religious Organization?

What are the sources of funding of the


9
Organisation?

Has the Organisation received any


10
awards/recognition for its work? Kindly mention

Does it receive funds / implement programs for


11
the government? If yes-details

Has the Organisation been successful in handing


12 over projects/making projects sustainable? Give
example

Has the Organisation been blacklisted by


13 government/PSU or any corporate? If yes,
reasons for it

Is the Organisation empanelled by any reputed


14
institute or agency? If yes, give details

Is the Organisation associated with any other


15 corporate for implementing CSR projects?
Mention names

16 Total turnover in the last 3 financial years


17 Strength of staff (number of full time employees)

Any past projects with BPCL/other PSU’s If yes


18
then details thereof

19 Qualification/experience of staff/project team

Please provide two references of past funders of


20 your projects (Email id/ Contact Person with
Designation/ Contact Number)

Have you filled all the information in the


21
proposal?

Form D

Summary Sheet for the Proposal

Title of the project

Project Description (Write a brief description of project)

Name of Executing Organisation

Address of Organisation (Registered address &


address of branch from which proposal is given)

Contact Person

Contact Number & email address


(Mention no. of years of experience & short
Experience of the Organisation brief about other projects executed)

Place of execution of project

Reason for choice of place

Tenure of the project

Cost of the project


(enclose a detailed budget)

Funds requested from BPCL

Funds requested from any other sources if any

Objective of the project

(mention nearest BPCL Business unit, whether the


Reason of Organisation preferring BPCL to be proposal is in line with BPCL thrust area & justify
part of this project why BPCL should consider the proposal)

Benefits/Outcomes expected from the project

1.
2.
Quantitative (Mention as per parameter suitable, 3.
but make sure to mention number of beneficiaries 4.
) 5.

1.
Qualitative (parameters which are difficult to 2.
capture in numbers) 3.

Requirement of any approval from local


bodies/government/municipality or any statutory
body Yes or No, If yes, give details in short

Whether similar projects executed earlier? Yes or No, If yes, give details in short
In case the proposal is approved, the organisation
is okay to open separate bank account for BPCL?
(Yes/No)

Information given above is true and we can


provide the documentary proof of it in case of (seal of the Organisation & signature of an
enquiry authorised person from the Organisation)

Form E

Track Record of Projects

(Kindly mention projects undertaken in the last 3 years. If an organisation is existing for 3
years, track record from inception till date is required)

Sr. Project Focus Area Location Period (To Value Number of Partner
No. Description - From) in INR Beneficiaries Name
Lakhs (Funding
Agency)
1 Skilling Skill Mumbai April 2015- XYZ 500 ABC
unemployed Development 2016 Lakhs
youth
2
3
4
5
6
7
8

Form F

Declaration

I / We hereby declare and certify that all the information given in the application form and in
the documents submitted are true and correct to the best of my knowledge.

I / We acknowledge that in case of misrepresentation of information or furnishing of false


information, my application is liable to be rejected and /or approved project is be liable to be
terminated by BPCL at any stage.
I / We further declare and certify that our organisation / company / group of companies has /
have not been blacklisted or been put on the holiday list by any of the Public Sector
Undertakings in India or Statutory authority or Government.

Signature ……………………………..

Name………………………………….

Designation…………………………..

Seal of the Organisation.………………………….

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