APPLICATION FOR REGISTRATION OF CHILD CARE INSTITUTION UNDER THE JUVENILE

JUSTICE (CARE AND PROTECTION OF CHILDREN) ACT, 2015

To,
The Women and Child Development Department,
Government of Maharashtra.

1. Detail of Applicant/ Institution which proposes to run the Child Care Institution:
(i) Type of Institution as per section 2 (21) of the Juvenile Justice (Care and Protection of Children) Act 2015   Select Observation Home Special Home Place of Safety Children’s Home Open Shelter Other

(ii) Name of the Institution / Organization    

(iii) Registration number and date of Registration of the Institution/ Organization under the relevant Act (Annex- Attested relevant documents of registration and bye-laws, memorandum of association) and its provisions for running child care institutions ; resolution of the governing for running the Child Care Institution.    

(iv) Period of validity to run the Institution / Organization  

(v) Complete address of the Applicant/ Institution/ organization  

(vi) STD code/ Telephone No.  

(vii) STD code/ Fax No  

(ix) Whether the organization is of all India character, if yes, give address of its branches, in other states   Please specify state or districts of operations.

(x)Whether the Institution/ Organization had been denied registration earlier Ref. No. of application which resulted in denial of registration as Child Care Institution
a) Date of denial.  
b) Which department has denied the registration

(xii) Reason for denial of registration as CCI

(xiii) Whether institution/ organisation has been blacklisted:

• 2. Details of the proposed Child Care Institution
• Name of the proposed Child Care Institution.. 
 
• i. Type/Kind of Child Care Institution.. 
• ii. Complete address/ location of proposed child Care Institution or organization
• iii. STD code/ Telephone No.
• iv. STD code /Fax No.
• v. E-mail address.  
• Whether proposed premises of the Child Care Institution is Owned/Rented : Select Owned Rented