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Animal Welfare Board of India: A Pplication Form For Honoray Animal Welfare Officer (State / District)

This document contains an application form for the position of Honorary Animal Welfare Officer (State/District) with the Animal Welfare Board of India. The 18-question form requests information such as the applicant's name, father/spouse's name, date of birth, address, educational qualifications, details of any animal welfare organization they belong to, animal welfare activities and experience, and a declaration that they have not been involved in animal cruelty cases. The final section notes that a Rs. 500 application fee must be paid and registration is required to be renewed every 5 years.

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286 views3 pages

Animal Welfare Board of India: A Pplication Form For Honoray Animal Welfare Officer (State / District)

This document contains an application form for the position of Honorary Animal Welfare Officer (State/District) with the Animal Welfare Board of India. The 18-question form requests information such as the applicant's name, father/spouse's name, date of birth, address, educational qualifications, details of any animal welfare organization they belong to, animal welfare activities and experience, and a declaration that they have not been involved in animal cruelty cases. The final section notes that a Rs. 500 application fee must be paid and registration is required to be renewed every 5 years.

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© © All Rights Reserved
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ANIMAL WELFARE BOARD OF INDIA

Ministry of Fisheries, Animal Husbandry and Dairying, Govt. of India


(Department of Animal Husbandry and Dairying)
NIAW Campus, 42 KM Mile Stone, Delhi-Agra Highway
NH-2, Ballabhgarh, Haryana-121004
Email: a [email protected] : Website: w ww.awbi.in

A PPLICATION FORM FOR HONORAY ANIMAL WELFARE OFFICER (STATE / DISTRICT)


(Please fill in capital letters)

1) Name of the applicant :

2) Name of Father / Spouse : PHOTO

3) Date of Birth (DD/MM/YYYY) :

4) Sex :

5) Aadhaar Card ID No. :


(enclose self attested copy)

6) Complete address with Pin Code :

7) Contact No. (Telephone/Mobile/email) :

8) Educational Qualification :

9) Name & Address of the Organization


to which he/she belongs :

10) Brief Description of the Organization :


(Including animal welfare
activities, kinds of animals handled)

11) Your involvement with this organization :


12) Animal Welfare Activities done so far :

13) Participation in Animal Welfare


Training Programmes (if any) :

14) Any other relevant particulars to


support your application :

15) Language known :

16) Name of the Recommending Authority :


(With signature and seal)
(Member, AWBI/State Animal Welfare Board/
Animal Husbandry Department/ District Collector/
District SPCA)

17) An application fee of Rs. 500/- in the


form of Cheque / Pay Order / Demand
Draft in favour of “Animal Welfare Board
of India” payable at Ballabhgarh shall be
made.

18) The Registration is to be renewed after


every five years.

Signature of the Applicant


DECLARATION

I Mr. / Ms……………………………………..S/o, D/o, W/o………………………………………..

R/o…………………………………………………………………………………………………………………

……………………………..do hereby solemnly affirm and declare as under:

1. That I am citizen of India.

2. That I am consenting to act as Honorary Animal Welfare Officer (State / District).

3. That I have never been changed, convicted or sentenced in any case of animal cruelty
and violation of Prevention of Cruelty to Animals Act, 1960.

4. That I have not filed/represented/ appeared in any Animal Cruelty and related matters
against AWBI and / or Govt. of India.

5. That I have read and understood all the terms and conditions and I will be following all
in violation of which the Animal Welfare Board of India can cancel my nomination at
any time.

6. That all the information provided and declaration made by me are true and correct to the
best to my knowledge and believe and nothing material is concealed therefrom.

Signature

Date:……………………………..

Place:……………………………..

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