eoi-public private partnership (ppp)project for primary health centres

GOVERNMENT OF PUNJABDEPARTMENT OF HEALTH & FAMILY WELFARENATIONAL RURAL HEALTH MISSION5 TH FLOOR, PRAYAAS BUILDING, DAKSHIN MARG, SECTOR 38-B, CHANDIGARH-160036Tel. No. 0172-4012011-13, 4012030 (Telefax)PUBLIC PRIVATE PARTNERSHIP (PPP) PROJECT FOR IMPROVEMENT OF THEHEALTH DELIVERY SYSTEM IN PUNJABApplication Form for Expression of Interest (EOI) by NGOs/ VoluntaryOrganisations / Non-Commercial Hospitals to run Primary Health Centre1. Name of the Agency :2. Legal Status (Society, Trust etc….):Registration Details in India.3. Please enclose a copy of Byelaws and the:Memorandum of Association4. Please enclose the details of top Management/:Executive Board5. FCRA Permission, if any, please gives details:6. Location of Headquarters in India:7. Existing Geographical Areas of Operation:8. Please enclose details of functional areas of:operation and major works/projects undertakenin India, State wise in the last 3 years.9. Please furnish details of the Income and Expenditurefor the last 3 years:10. Please separately detail the organization structureand personnel employed on regular/ contractbasis in different States in India:11. Please mention your specific experience in the :area of Health and Family Welfare :12. Resource (Financial/Human/others) which can be :committed by the NGO per year for the proposedproject in PunjabSignature(Authorised Signatory)Note :1. Please send this form duly filled in along with the relevant details to theMD-NRHM, Department of Health & Family Welfare, Government of Punjab,so as to reach latest by 15 th July, 2011, O/o Mission Director, National RuralHealth Mission, Prayas Building, 5 th Floor, Sector-38-B, Chandigarh.