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Annexue F

This document is a form for candidates to provide information about cleanliness habits and facilities in their home. It requests the candidate's name, address, family information including number of members and toilet users. It also asks if a toilet is available, reasons why not, and handwashing habits before food and after using the toilet. The candidate must undertake to convince family members of the importance of a toilet, construct one within three months if unavailable, and ensure regular toilet use by all family members.

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Omkar Jagtap
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22 views

Annexue F

This document is a form for candidates to provide information about cleanliness habits and facilities in their home. It requests the candidate's name, address, family information including number of members and toilet users. It also asks if a toilet is available, reasons why not, and handwashing habits before food and after using the toilet. The candidate must undertake to convince family members of the importance of a toilet, construct one within three months if unavailable, and ensure regular toilet use by all family members.

Uploaded by

Omkar Jagtap
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPENDIX F

Form for filling up the information by the candidate desirous of seeking admission
regarding the habit of cleanliness and facilities available at his/her home

.......................................................................................
1

Name

Permanent
Residential
Address

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

Family
information

No. of family members.


No. of members utilising the W/C (Toilet) -

Availability of
W/C (Toilet)

Yes

.......................................................................................
:
:

No

If the W/C (Toilet) is not available give the specific reason.


........................................................................................................
5

Habit of
Handwash

Before Food- Yes

No.

If yes- With Soap


If Toilet- Yes
If yes- With Soap
6

Undertaking

With Water

Other

No
With Water

Other

I have read the appeal made by the Organisation regarding


importance of W/C (Toilet) and its day to day use. I will
convince all my Family Members regarding importance of W/C
(Toilet) manage to construct the W/C (Toilet and manage to
construct the W/C (Toilet) within a period of three months (If
not available) and I promise that all my family members will
use W/C (Toilet) regularly.

Date
Signature

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