Anna University Sports Board

Check List
(Local Sports Coordinator)

Sl.No Details Please verify and Tick

1. Audited Statement of Account

2. Utilization Certificate

3. Balance amount (of the grant) returned (if any)

4. Cover containing unused Medals / Certificates

Local Sports Secretary Local Sports Coordinator

Name: Name:

Office seal with date

1
 Anna University Sports Board

Check List
(Local Sports Coordinator)

Sl.No Details Please verify and Tick

1. University Team

2. List of Selection Committee Members furnished

3. Results furnished

4. List of Teams Participated

5. List of Referees furnished

6. Details of Players furnished

7. Details of Medals and Certificates furnished

i. Number of Medals returned, if any:

ii. Number of Certificates returned, if any:

Local Sports Secretary Local Sports Coordinator

Name: Name:

Office seal with date

2
 Anna University Sports Board

Selected Players for University Team

Main Team

Name of the Player &

Sl. No Position Institution
Course of Study

3
 Anna University Sports Board

Selected Players for University Team

Reserve Team

Name of the Player &

Sl. No Position Institution
Course of Study

4
 Anna University Sports Board

Selected Players for University Team

Additional Reserve Team

(for summer coaching camp)

Name of the Player &

Sl. No Position Institution
Course of Study

5
 Anna University Sports Board

Details of Selection Committee Members

Game: Dates of the Tournament:
Venue:
Sl.No Name, Designation & Address Signature

10

11

12

13

14

15

Local Sports Coordinator

Local Sports Secretary

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 Anna University Sports Board
Office seal with date

Results

Game: Dates of the Tournament:

Venue:

Zonal Winning Team Line-up

Position Name of the Institution

II

III

IV

Zonal Combined Winning Team Line-up

(for the consolation prizes only)
Position Name of the Zone

II

III

IV

Local Sports Secretary Local Sports Coordinator

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 Anna University Sports Board
Office seal with date

List of Teams Participated

Game: Dates of the Tournament:
Venue:
No. of teams participated:

Sl.No College Name

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Local Sports Secretary Local Sports Coordinator

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 Anna University Sports Board
Office seal with date
Game: Dates of the Tournament:
Venue:
Fixtures

Local Sports Secretary Local Sports Coordinator

9
 Anna University Sports Board
Office seal with date

Details of Referees
Game: Dates of the Tournament:
Venue:

Sl.No Name, designation & Address Signature

1

10

11

12

13

14

15

Local Sports Secretary Local Sports Coordinator

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 Anna University Sports Board
Office seal with date

Details of Players
(Zonal Winning Team)
(format)
Zone: Dates of the Tournament:
Game: Venue:
Name of Institution:

Sl.No. Name of the Player Register No. Year/ Date of Signature

Branch Birth
1

10

11

12

13

14

15

16

Director of Physical Education Head of the Institution

(Manager)

Office seal with date

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 Anna University Sports Board
Details of Players
(Zonal Winning Team)
Zone: Dates of the Tournament:
Game: Venue:
Name of Institution:

12
 Anna University Sports Board
Details of Players
(Zonal Winning Team)
Zone: Dates of the Tournament:
Game: Venue:
Name of Institution:

Details of Players
(Zonal Winning Team)
Zone: Dates of the Tournament:
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 Anna University Sports Board
Game: Venue:
Name of Institution:

Details of Players
(Zonal Winning Team)
Zone: Dates of the Tournament:

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 Anna University Sports Board
Game: Venue:
Name of Institution:

Details of Players
(Zonal Winning Team)
Zone: Dates of the Tournament:
Game: Venue:

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 Anna University Sports Board
Name of Institution:

Details of Players
(Zonal Combined Team)
(format)

Game: Date of the Tournament:

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 Anna University Sports Board
Venue:

Sl.No. Name of the Player Register Year/ Date of Name of Signature

No. Branch Birth the
Institution
1

10

11

12

13

14

15

16

Local Sports Secretary Local Sports Coordinator

Name: Name:

Office seal with date

Details of Players
(Zonal Combined Team)

Game: Date of the Tournament:

Venue:

17
 Anna University Sports Board

Details of Players
(Zonal Combined Team)

Game: Date of the Tournament:

Venue:

18
 Anna University Sports Board

Details of Players
(Zonal Combined Team)

Game: Date of the Tournament:

Venue:

19
 Anna University Sports Board

Details of Players
(Zonal Combined Team)

Game: Date of the Tournament:

Venue:

20
 Anna University Sports Board

Details of Players
(Zonal Combined Team)

Game: Date of the Tournament:

Venue:

21
 Anna University Sports Board

AUDITED STATEMENT OF ACCOUNT

Name of the Organizing College :

Zone :

Game :

Section :

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 Anna University Sports Board
Dates of Tournament :

Details of grant received from the Chairman, AUSB:

DD/ Cheque No: Date: Amount:

Certified that I have audited the accounts of Inter-Zonal tournament for the year
2017 - 18 organized by …………………………………………………………………….

The details of expenditure are given below:-

1 Ground Preparation :Rs.

2 Officiating Charges :Rs.

3. Hospitality and Contingencies :Rs.

Total

(Rupees ___________________________________________________________only)

4. Details of balance amount returned (if any): Nil

DD/ Cheque No: Date: Amount

Also certified that a sum of Rs……… / Nil was received from other sources.

Chartered Accountant
(Signature and Seal)

Local Sports Secretary Local Sports Coordinator

Office seal with

UTILIZATION CERTIFICATION

Name of the Organizing College :

Zone :

Game :

Section :
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 Anna University Sports Board
Dates of Tournament :

Details of grant received from the Chairman, AUSB:

DD/ Cheque No: Date: Amount:

Certified that the amount sanctioned towards the conduct of Inter-Zonal

tournaments for the year 2017 - 18 organized by ………………………………………….
…………………has been utilized for the purpose for which it was sanctioned.

The statement of expenditure are given below:-

1 Ground Preparation :Rs.

2 Officiating Charges :Rs.

3. Hospitality and Contingencies :Rs.

Total

(Rupees only)

4. Details of balance amount returned (if any):

DD/ Cheque No: Date: Amount

Signature
Local Sports Coordinator

Name:
Office seal with date

Candidate
Signature should
ANNA UNIVERSITY, CHENNAI – 25 be on top of the
Photo
ELIGIBILITY PROFORMA OF PLAYERS PHOTO
to be attested by
Zone No. the Principal

1 Name of the Student

2 Game

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 Anna University Sports Board
3 Father’s Name

4 Mother’s Name

5 Name of the College

6 Date of Birth & Age

7 Address for Communication

Mobile :
Landline :
8 Permanent Residential Address

9 Month & Year of Passing +2 / 10 Examination

10 Current Course of Study in Anna University 1. UG / PG :

2. Year : I / II / III / IV
3. Branch :
11 Anna University Examination Registration No.
12 Details of UG Study Name of UG Programme :
(for PG students) College of Study :
Year of Admission :
Year of Completion :
13 Period of break of study (if any)

14 Details of earlier representation in

University team *
15 Details of participation in National /
International Tournaments *
16 Size of Uniform (√ the right size)
36 38 40 42 44 46
Enclosure :
(i) Attested copy of the +2 mark sheet / Diploma Certificate
(ii) Attested copy of the AU examination recent Hall Ticket / fee receipt for I year / recently received Semester
Mark Sheet.
(iii) Attested copy of the degree certificate in case of PG students.
(iv) Attested copy of Form III / II / I *
Signature of the Student

Signature of the Principal Signature of DPE

College Seal

25