Form No.

Nehru Yuva Kendra Sangathan (NYKS)

YouthClubAffiliation( )/Updation( ) Form

State: District: Block:

1. Name and full Address of Youth Club:___________________________________________ Paste Photo
____________________________________________________________________________________
President /
______________________________________ P.O with pincode___________ General
Secretary
2. Contact Details a. Club email id:
b. Club Ph.No. (Call/Whatsapp):
3. Establishment detail of Club:
a. Date of Establishment : (_ _ / _ _ / _ _ _ _)
b. Whether Registered :Yes ( ) No ( )
i.Regd. No. ( as per Societies Registration Act 1860 or any other State Act):_
ii.Date of Last Registration : (_ _ / _ _ / _ _ _ _ ) and attach certificate
4. Infrastructure of Youth Club:
a.Does the Club has its office in the village (Please√ticktherightbox):Yes( )No()
b.Own Building( )On Lease( )Rented( )Part of Village Asset( )Rent Free Building( )

5. Whether the Youth Club has ever received Financial Assistance (Grant in Aid) from any
otheragency (Please√tick):CentralGovt.( )StateGovt.( )OtherAgency( )
6. Whether Club is maintaining its account(Please√tick): Yes( )No( )
If“Yes”: Account maintained in(Please√tick): Bank( ) andAccount No. _______
_____________________________________________________(prefer Nationalised bank/SBI)

8. Whether the Youth Club has its Memorandum of Association (MoA)/ By Laws :
Yes( )No( )If“Yes”enclose the Photocopy of MoA.
9. Activities of Club :Sports :___________________________________________________
Arts:
Other activity:
10. NYKS Activities you would like to participate in : ( ) Sports ( )Culture ( )Adventure ( )Skill Training
( )Life Skills Education ( )Leadership & Development ( )Other (Please specify)

DECLARATION
I hereby declare that the above information provided is correct and true. In this regard, the evidence
can be produced and would be open for physical verification by NYK and designated person. It
iscertified that the Club has_ Male and Female membership as on date.

Signature of Youth Club

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Place: Date: President / General Secretary

Enclose : Copy of -1. Registration certificate, 2. By-law 3. Bank passbook front page 4. Club Meeting minutes deciding on affiliation
Note : President/Secretary MUST be in15-29 age group, AND minimum 10 members in the age group (15-29).
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