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Account of Foreign Contribution (FC) for the year ending on the 31st March_____

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..... (c) Foreign Contribution received during the financial year: (i) Directly from a foreign source: (ii) From a local source: (d) Total Foreign Contribution (a+b+c) (Rs.): * i.e. interest accrued on foreign contribution, or any other income derived from foreign contribution, e.g. sale proceeds from assets created from foreign contribution, or interest thereon during the year, income from projects/activities. (ii) (a) Donor wise detail of foreign contribution received: Sl. No. Name of donor(s) Institutional / Individual Details of the donor: official Address; email address; Website address; Purpose(s) for which received (Social, Cultural, Educational, Economic, Religious) Specific Activity/ project Amount Rs (1) (2) (3) (4) (5) (6) (7) (b) Cumulative purpose-wise amount of all foreign contribution donations received: 3. Details of utilisation o .....

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..... (d) FC transferred to other associations Sl. No. Name of the association Date Purpose Amount (1) (2) (3) (4) (5) Total (e) Total utilisation in the year (Rs.) (b+c+d): 4. Details of unutilised foreign contribution: (i) Total FC invested in term deposits (Rs.): Sr. No. Details Total (in Rs.) (i) Opening Balance of FD (ii) FD made during the year (iii) Less: realisation of previous FD Closing balance of FD (ii) Balance of unutilised foreign contribution, in cash/bank, at the end of the year (Rs): (a) Cash in hand: (b) in FC designated bank account: (c) in util .....

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..... and Pin Code, if registered society, its registration number and State of registration) for the financial year ending the 31st March _____and examined all relevant books and vouchers and certify that according to the audited account: (i) the brought forward foreign contribution at the beginning of the financial year was Rs.___; (ii) foreign contribution of / worth Rs. ____was received by the Association during the financial year ____ ; (iii) interest accrued on foreign contribution and other income derived from foreign contribution or interest thereon of/worth Rs. ____ was received by the Association during the financial year _____ ; (iv) the balance of unutilised foreign contribution with the Association at the end of the financial year ____was Rs.____ ; (v) Certified that the Association has maintained the accounts of foreign contribution and records relating thereto in the manner specified in section 19 of the Foreign Contribution (Regulation) Act, 2010 (42 of 2010) read with rule 17 of the Foreign Contribution (Regulation) Rules, 2011. (vi) The information in this certificate and in the enclosed Balance Sheet and sta .....

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..... emorandum of Association and/or the Articles of Association, if applicable); (b) Main object(s) and definite programme(s) for which the foreign contribution is to be accepted/utilised: (v) Details of names and addresses of the members of the Executive Committee/Governing Council etc. of the Association, starting with the Chief Functionary, in the following table: Sl. No. Name Name of father/husband Nationality Occupation with address of place of work (at the time of filing the application. Phone/mobile no. if available) Post held in the Association Relationship with other Member(s) of the Exe. Council/Governing body Address for correspondence (vi) If this association is branch/unit/associate of any organisation based abroad or of another association already registered or granted prior permission under the Act, the name and address of the parent organisation: 2. Details of Fee: An .....

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..... Act to seek prior permission by the Central Government. If so, the number and date of the relevant order: (d) had earlier been proceeded against as per the provisions of the Foreign Contribution (Regulation) Act 1976 (49 of 1976): 6.Whether: (i)(a) the association was granted prior permission to receive foreign contribution under the Act . If so, the Ministry of Home Affairs letter number with date granting such prior permission: (b) whether the account of the receipt and utilisation of the foreign contribution received above was sent to the Central Government in the prescribed FC-3 Form. The date of submission of the accounts be indicated: (ii) Whether : (a) the Association has received foreign contribution without the prior permission under the Act in the past. If so, full particulars of the foreign contribution received along with complete address of the bank branch and bank account number in which deposited should be furnished: (b) said violation has been condoned by the Central Government: 7. I affirm that the applicant Association is not an owner, printer, publisher, editor of a publication which is registered as newspaper under the Press and Registra .....

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..... declare that the above particulars furnished by me are true and correct and undertake to: (i) to inform the Central Government (Ministry of Home Affairs) within thirty days, if any change takes place in regard to the name of the Association, its address, its registration, its nature, its aims and objects together with documentary evidence effecting the change. (ii) to intimate within thirty days regarding the change of Members of the Executive Committee/Governing Council, if, at any point of time, such change causes replacement of 50% or more of such Members as were mentioned in the application no. . Dated .. for registration under the Foreign Contribution (Regulation)Act, 2010 (42 of 2010) and undertake further not to accept any foreign contribution except with prior permission till the permission to replace the office-bearer(s) has been granted. (iii) not to change the Bank and/or branch of the Bank without prior permission of the Central Government [the reason(s) for change of bank or branch of the bank shall have to be relevant and justifiable] and, Note: Proforma for change of Bank (or in the branch of the existing bank where exclusive foreign .....

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..... rs on its chosen . (Economic, Educational, Cultural, Religious and Social) field of activity. 3. Grant of prior permission to the aforementioned Association to accept foreign contribution under the Foreign Contribution (Regulation) Act, 2010 (42 of 2010) is recommended. (Recommending Authority)** (Seal of the Recommending Authority) @ Strike out which is not applicable ** (i) District Collector/District Magistrate (ii) Ministry/Department of the State Government (iii) Ministry/Department of the Central Government. 3. Substituted vide NOTIFICATION No. G.S.R. 199(E) dated 07-03-2019 before it was read as 2 [FORM FC - 4 [See rule 17] The Secretary to the Government of India, Ministry of Home Affairs, Foreigners Division (FCRA Wing) NDCC-II Building, Jai Singh Road New Delhi 110001 Subject: Account of Foreign Contribution for the year ending on the 31st March_________ 1. FCRA registration/ prior permission number and date: 2 . Details of receipt and utilisation of foreign contribution: (i) Foreign Contribution received in cash/ kind (value) (a) Brought forward foreign contribution at th .....

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..... reign State; or (F) harmony between religious, racial, social, linguistic or regional groups, castes or communities (iv) Balance of unutilized foreign contribution, in cash/bank, at the end of the year (Rs): (v) Total number of foreigners working (salaried/ in honorary capacity): 3 (a) Details of designated FC bank account for receipt of Foreign Contribution (As on 31st March of the year ending): Name of the Bank Branch Address (with PIN code) IFSC Code Account No. (1) (2) (3) (4) (b) Details of all utilization bank accounts for utilization of Foreign Contribution (As on 31st March of the year ending): Name of the Bank Branch Address (with PIN code) IFSC Code Account No. (1) (2) (3) (4) Declaration I hereby declare that the above particulars furnished by me are true and correct. I also affirm that the receipt of foreign contribution and its utilization have not bee .....

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