Innovative scheme under LGSP-3
Scheme Name: Union
Disable treatment Service Center
Specification: One
Location: ward
Number:03 , UP Name:Dhamsuna, Upazila Name: Savar, District Name:Dhaka
GPS Location (if possible): longitude:_____________ latitude:______________
_
Name of the tenderer / contractor:_____________________________________
Date of Completion:
_________________________________________________
Financial Year: 20181-8
Source of Fund: BBG
Category: General / 25% Large Scheme/ 30% Scheme Selected by
Women
Sector: ___________________________,
Sub-sector:_______________________
Amount: 2,50,000/=
Number of Beneficiaries: Male: , Female____________
Type of Direct Beneficiaries: Pigment Mother/ Lactating Mother/
Adolescent Girls or Boys/ School Going Child/ Third Gender/ Ethnic Group/
Others.........................
Photo of the scheme
(Image-1):_________________________________________
Photo of the scheme
(Image-2):_________________________________________
Description of the Scheme (Maximum 200 words):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Interview of any one beneficiary
Name of the Interview:
Interviewee Gender: Female
Interviewee Mobile:
Comments of Interviewee: _____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Name & Signature:
Designation:
Date:
