ISC Annual Contribution Form
Purpose
The purpose of the annual contribution is explicitly towards forging partnerships for the India
Sanitation Coalition (ISC) to help achieve its vision, mission and purpose as listed in the
attached brochure.
By partnering with ISC, you gain access to the collaborative strength of organizations in the
sanitation sphere, through which potential partnerships can develop for financial and/or
technical support. Through collaborative frameworks such as pooling of resources and of
learnings; and multi-stakeholder dialogue, ISC enables its partners to work towards
sustainable and scalable outcomes.
Definition and Eligibility Criteria for applying as an International NGO (iNGO)
Partner
For the purpose of this form an international Non-Governmental Organization (iNGO) is an
organization that is neither a part of a government nor a conventional for-profit business.
They may be funded by governments, foundations, businesses, or private persons but work in
an international context with a presence or influence in multiple countries.
In this same geographic context, the types of organizations which fit the eligibility criteria for
applying as an International NGO partner are:
I.
II.
III.
IV.
Not-for-Profit Organizations
For-Profit Social Organizations
Charitable/Development Foundations and Trusts
Academic and Research Institutions
The final authority for decisions on the partnership will be the ISC Steering Committee.
Process
Prospective partners are directed to submit the Contribution form through BOTH Online and
Postal modes. The details about the modes are given at the end of the form.
Annual Contribution by iNGOs
The Annual Contribution amount for international NGO partners is INR 11,000 only.
Duration
The ISC contribution will be valid till 1 year and will be renewable on an annual basis.
Privacy
All contact information provided by partners will be confidential. Partners will be able to
create their own profile page and manage their data themselves. The standard data protection
laws will apply to their information.
Important Note for filling the form

Kindly fill the word version of the form as provided.


After putting the digital signature of the authority, please convert the form
into pdf (you can use ‘save as’ option in MS-WORD and select ‘pdf’ in file
type).
Kindly email to us only the PDF version of this form
INTERNATIONAL NGO CONTRIBUTION FORM
Name of Organisation:
Address:
Pin:
Telephone:
Fax:
Address in Delhi (if any):
Pin:
Telephone (Off):
Fax:
PAN No:
TAN No.:
CEO/Chairman/President:
Designation:
Address:
Pin:
Telephone (Off):
Fax:
Mobile:
Email:
IMPORTANT: Please fill out the ISC stakeholder mapping survey at HERE
No. of employees (approx.):
Date of Registration:
Location of major branches:
How can your organization add value to ISC? (not more than 50 words)
Which ISC Taskforce (s) would your organization be interested in joining? You can select
as many as suitable. Please refer to the ISC brochure (attached) for the description of each Task
Force.
TASK FORCE -1
TASK FORCE – 2
Advocacy, Branding and Communication
Identification and Dissemination of Best
Practice
TASK FORCE - 3
TASK FORCE - 4
Engagement with Central and State
Governments
Partnerships and Collaboration
Kindly provide the details of representative/ nomination for the Task Force (s) in the
ANNEXURE.
DATE:
NAME & DESIGNATION:
SIGNATURE OF THE APPLICANT:
Documents to be submitted along with the duly filled application form:


Organisation Brochure or Profile
Copy of registration certificate
Modes for payment of Annual Contribution


Cheque/DD no. _______ dated ______ for INR ______ favoring FICCI - India
Sanitation Coalition payable in New Delhi. Please mention India Sanitation
Coalition at the back of the cheque/DD.
Bank Details for RTGS / SWIFT Payment
Beneficiary Bank Name: United Bank of India
Beneficiary Bank Branch Address: Tansen Marg, New Delhi – 110001
Beneficiary A/c No.: 0359018047803
Name of Account Holder: FICCI-India Sanitation Coalition
Type of Bank Account: Savings
NEFT / IFSC / RTGS Code: UTBI0TNM709(0 – Zero)
MIRC Code of Bank: 110027020
Online:
The duly filled and signed contribution form should be mailed to
[email protected]
By Post:
Please take a print out of this form and send the duly filled, in signed and stamped form to:
India Sanitation Coalition Secretariat
c/o Federation of Indian Chambers of Commerce and Industry (FICCI)
Federation House, 1 Tansen Marg, New Delhi 110001
ANNEXURE: Details of Nomination
(Please note that due to the scheme of work it would be preferable to nominate distinct
representatives in case more than one Task Force is chosen. The same representative can also
be nominated for all the Task Forces selected provided he/she is able to devote time for
meetings and work plan execution as per the terms of each Task Force. The representative(s)
should preferably be sector expert in the domain.
Details of Nominee for Task Force I
Name:
Designation:
Address:
Pin:
Telephone (Off):
Mobile:
Fax:
E-mail:
Name of personal Secretary (if any):
Telephone:
E-mail:
Details of Nominee for Task Force II
Name:
Designation:
Address:
Pin:
Telephone (Off):
Mobile:
Fax:
E-mail:
Name of personal Secretary (if any)::
Telephone:
E-mail:
Details of Nominee for Task Force III
Name:
Designation:
Address:
Pin:
Telephone (Off):
Mobile:
Fax:
E-mail:
Name of personal Secretary (if any)::
Telephone:
E-mail:
Details of Nominee for Task Force IV
Name:
Designation:
Address:
Pin:
Telephone (Off):
Mobile:
Fax:
E-mail:
Name of personal Secretary (if any):
Telephone:
E-mail:
About India Sanitation Coalition Secretariat (ISC)
FICCI serves as the project co-ordination office for the Coalition and is housing the
Secretariat.
Secretariat
Ms Rita Roy Choudhury
Senior Director & Head, Environment, Climate Change, Renewable Energy & Water Division, FICCI &
Head of India Sanitation Coalition Secretariat
Mr JVG Krishnamurthy
Programme Leader
Email: [email protected]
Ms Shipra Saxena
Program Manager
Email: [email protected]
Ms Amri Shahpuri
Program Assistant
Task Force on Partnerships and Collaborations
Email: [email protected]
Ms Medhavi Sharma
Assistant Director, Environment & Water Division,
Program Assistant, Task Force on Government Engagement
Email: [email protected]
Ms Vandana Nath
Program Assistant, Task Force on Best Practices
Email: [email protected]
Ms Zara Juneja
Program Assistant, Task Force on Advocacy, Branding and Communication
Email: [email protected]
Federation of Indian Chambers of Commerce and Industry (FICCI)
Federation House, 1 Tansen Marg, New Delhi 110001
T: +91-11-23487366
F: +91-11-23721504
Email: [email protected]
Website: www.indiasanitationcoalition.org
Facebook: www.facebook.com/india-sanitation-coalition-1646326518934691
Twitter: www.twitter.com/indsancoalition
LinkedIn: www.linkedin.com/company/india-sanitation-coalition