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Format of Test-Check Report Under ADIP Scheme

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Format of Test-Check Report Under ADIP Scheme Format of Test-Check Report under ADIP Scheme Test Check (Minimum of 10/15 percent*) of beneficiaries assisted during the year 2020-21 Name of the Implementing Agency - SVNIRTAR, Olatpur PART-I State: WEST BENGAL District: PASCHIM MEDINPUR Sl. No. Name of Benificiary Father's/Husband's Male/ Age Complete Address Contact Type of Aid Place of Date of Date of Test name Female Number given Camp Camp Check surgical working check(e.g. distribution Whether any confirmed & Finding of test- Sl. No. of list of correction taken well/distribution the covered Beni. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 AT SONAKHALI PO AT SONAKHALI PO SONAKHALI PS DASPUR SONAKHALI PS BIL. BTE H/A PASCHIM Working well & DIST WEST MEDIPUR , DASPUR DIST ALPS TUBO CAP MEDINPUR 1 1 PRIYANKA DAS F 18Y Nil Distribution WB WEST MEDIPUR , I WITH IN B , WEST confirmed 12.01.2021 WB EARS BENGAL 12.01.2021 9732812784 AT DIYAL CHAIPAT PO AT DIYAL CHAIPAT PO CHAIPAT PS CHAIPAT DIST CHAIPAT PS CHAIPAT BIL. BTE H/A PASCHIM WEST MEDINPUR WB DIST WEST MEDINPUR Working well & ALPS TUBO CAP MEDINPUR 2 2 RIMPA MAITY F 25Y WB Nil Distribution I WITH IN B , WEST confirmed 12.01.2021 EARS BENGAL 12.01.2021 9647020323 AT BAIKUNTHPUR PO AT BAIKUNTHPUR PO SHANKALPUR PS DASPUR SHANKALPUR PS BIL. BTE H/A PASCHIM DIST WEST MEDINPUR WB DASPUR DIST WEST Working well & ALPS TUBO CAP MEDINPUR 3 3 SABER KHAN M 16Y MEDINPUR WB Nil Distribution I WITH IN B , WEST confirmed 12.01.2021 EARS BENGAL 12.01.2021 7738318311 AT PALASHPARI PO AT PALASHPARI PO PALASHPARI PS DASPUR DIST PALASHPARI PS BIL. BTE H/A PASCHIM PASCHIM MEDINPUR WB DASPUR DIST Working well & ALPS TUBO CAP MEDINPUR 4 4 KRISHNENDU BERA M 16Y PASCHIM MEDINPUR Nil Distribution I WITH IN B , WEST WB confirmed 12.01.2021 EARS BENGAL 12.01.2021 9932736427 AT SITAPUR PO SITAPUR PS AT SITAPUR PO DARAPUR DIST WEST SITAPUR PS DARAPUR BIL. BTE H/A PASCHIM MEDINPUR WB DIST WEST MEDINPUR Working well & ALPS TUBO CAP MEDINPUR 5 5 SAYANTI ROY F 18Y WB Nil Distribution I WITH IN B , WEST confirmed 12.01.2021 EARS BENGAL 12.01.2021 9734353752 AT SHRIDHARPUR PO AT SHRIDHARPUR PO RADHAKANTAPUR PS RADHAKANTAPUR PS BIL. BTE H/A PASCHIM KASPUR DIST WEST KASPUR DIST WEST Working well & ALPS TUBO CAP MEDINPUR 6 6 KUHU RAJPANDIT MEDINIPUR WB F 21Y MEDINIPUR WB Nil Distribution I WITH IN B , WEST confirmed 12.01.2021 EARS BENGAL 12.01.2021 9800127526 AT JORKERHAB PO AT JORKERHAB PO PALARHPAI PS DASPUR DIST PALARHPAI PS BIL. BTE H/A PASCHIM WEST MEDINPUR WB DASPUR DIST WEST Working well & SUBHANKAR ALPS TUBO CAP MEDINPUR 7 7 M 31Y MEDINPUR WB Nil Distribution CHAUDHURI I WITH IN B , WEST confirmed 12.01.2021 EARS BENGAL 12.01.2021 9679456353 AT GOURA PO LAKSHMAN AT GOURA PO CHAK PS DASPUR DIST WEST LAKSHMAN CHAK PS BIL. BTE H/A PASCHIM MEDINPUR WB DASPUR DIST WEST Working well & ALPS TUBO CAP MEDINPUR 8 8 ANUKUL JANA M 70Y MEDINPUR WB Nil Distribution I WITH IN B , WEST confirmed 12.01.2021 EARS BENGAL 12.01.2021 9679747177 AT SOYLA PO SONAKHALI PS AT SOYLA PO DASPUR DIST WEST SONAKHALI PS BIL. BTE H/A PASCHIM MEDINPUR WB DASPUR DIST WEST Working well & ALPS TUBO CAP MEDINPUR 9 9 MADAN KURAR M 70 MEDINPUR WB Nil Distribution I WITH IN B , WEST confirmed 12.01.2021 EARS BENGAL 12.01.2021 9679182246 AT KUNDU PO KHUKUMDA AT KUNDU PO PS DASPUR DIST WEST KHUKUMDA PS PASCHIM MEDINPUR WB DASPUR DIST WEST Working well & LAKSHMIKANTA WALKING STICK MEDINPUR 10 10 M 52 MEDINPUR WB Nil Distribution DANDAPAT AND PAC-40 , WEST confirmed 12.01.2021 BENGAL 12.01.2021 7550883237 AT MAHALPDA PO AT MAHALPDA PO SANAKHALI DIST WEST SANAKHALI DIST PASCHIM MEDINPUR WB WEST MEDINPUR WB WHEEL CHAIR Working well & MEDINPUR 11 11 DEBASIS SAMANTA M 34Y ADULT AND Nil Distribution , WEST WALKING STICK confirmed 12.01.2021 BENGAL 12.01.2021 9732772240 AT WEST MEDINPUR WB AT WEST MEDINPUR WB PASCHIM Working well & MEDINPUR 12 12 SK. SERAJUL ISLAM M 30 Y PAC-39 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 7584966800 AT P. DASPUR PS DASPUR AT P. DASPUR PS DIST PASCHIM MEDINPUR DASPUR DIST PASCHIM WB PASCHIM MEDINPUR Working well & MEDINPUR 13 13 AJAY HASENABARTY M 30Y WB PAC-39 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 9932544378 AT WEST MEDINPUR WB AT WEST MEDINPUR WB PASCHIM Working well & MEDINPUR 14 14 MINATI PATRA F 55Y PAC-40 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 9932027058 AT SRIPUR PO AT SRIPUR PO JAGANATHPUR PS DASPUR JAGANATHPUR PS PASCHIM DIST WEST MEDINPUR WB DASPUR DIST WEST Working well & MEDINPUR 15 15 ANIL MAITI F 30Y MEDINPUR WB PAC-40 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 8972884418 AT SRIPUR PO AT SRIPUR PO JAGANNATHPUR PS DASPUR JAGANNATHPUR PS PASCHIM DIST WEST MEDINPUR WB DASPUR DIST WEST Working well & MEDINPUR 16 16 ANIL MAITI M 30 MEDINPUR WB PAC-40 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 8972884418 AT PUKAIPAHE PO PUKUE AT PUKAIPAHE PO DUHAI PS DASPUR DIST PUKUE DUHAI PS PASCHIM PASCHIM MEDINPUR WB DASPUR DIST Working well & MEDINPUR 17 17 ADHIR PAUJA M 66 PASCHIM MEDINPUR PAC-40 Nil Distribution , WEST WB confirmed 12.01.2021 BENGAL 12.01.2021 9775616985 AT DASPUR DIST WEST AT DASPUR DIST MEDINPUR WB WEST MEDINPUR WB PASCHIM Working well & MEDINPUR 18 18 GAUR DAS M 56Y X PAC-40 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 AT DASPUR DIST WEST AT DASPUR DIST MEDINPUR WB WEST MEDINPUR WB PASCHIM Working well & MEDINPUR 19 19 GOUTAM BERA M 43Y PAC -40 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 9732536219 AT JHOTGHANSHYAM DIST AT JHOTGHANSHYAM WEST MEDINPUR WB DIST WEST MEDINPUR PASCHIM WB Working well & MEDINPUR 20 20 RANJIT BERA M 60Y WHEEL CHAIR Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 9732769272 AT KULTIKARTI DIST AT KULTIKARTI DIST PASCHIM MEDINPUR WB PASCHIM MEDINPUR PASCHIM WB WHEEL CHAIR Working well & MEDINPUR 21 21 GANESH MAJHI M 30Y X ADULT AND Nil Distribution , WEST WALKING STICK confirmed 12.01.2021 BENGAL 12.01.2021 AT SRIBORA PO SRIBORA PS AT SRIBORA PO DASPUR DIST WEST SRIBORA PS DASPUR PASCHIM MEDINPUR WB DIST WEST MEDINPUR WHEEL CHAIR Working well & MEDINPUR 22 22 GOPAL SANTRA M 56 WB ADULT AND Nil Distribution , WEST WALKING STICK confirmed 12.01.2021 BENGAL 12.01.2021 8927079605 AT BRINDABAN CHAK PO AT BRINDABAN CHAK BRIN DABAR CHAK DIST PO BRIN DABAR CHAK PASCHIM PASCHIM MEDINPUR WB DIST PASCHIM Working well & MEDINPUR 23 23 DIPAK PRAMANIK M 42 MEDINPUR WB PAC-40 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 9734619775 AT DASPUR DIST WEST AT DASPUR DIST MEDINPUR WB WEST MEDINPUR WB PASCHIM WHEEL CHAIR Working well & MEDINPUR 24 24 BISAL PAL M 19 ADULT AND Nil Distribution , WEST PAC-40 confirmed 12.01.2021 BENGAL 12.01.2021 9547495022 AT LAKOHMI KUNDA PO AT LAKOHMI KUNDA KASHINATHPUR PS DASPUR PO KASHINATHPUR PS PASCHIM DIST WEST MEDINPUR WB DASPUR DIST WEST WHEEL CHAIR Working well & MEDINPUR 25 25 SATYAPRAKASH JANA M 28 MEDINPUR WB ADULT AND Nil Distribution , WEST WALKING STICK confirmed 12.01.2021 BENGAL 12.01.2021 7076908252 AT DASPUR DIST WEST AT DASPUR DIST MEDINPUR WB WEST MEDINPUR WB PASCHIM Working well & MEDINPUR 26 26 SWAPAN MANDAL M 18 PAC-40 Nil Distribution , WEST confirmed 12.01.2021 BENGAL 12.01.2021 7501346622 AT MAHAKALPOTH PO AT MAHAKALPOTH PO SONAKHALI PS DASPUR DIST SONAKHALI PS PASCHIM WEST MEDINPUR WB DASPUR DIST WEST Working well & TRICYCLE AND MEDINPUR 27 27 RUPA RANA F 42 MEDINPUR WB Nil Distribution PAC-40 , WEST confirmed 13.01.2021 BENGAL 13.01.2021 9733322789 AT DAULATCHALK PO AT DAULATCHALK PO MANSUGAON PS DASPUR MANSUGAON PS PASCHIM DIST WEST MEDINPUR WB DASPUR DIST WEST Working well & TRICYCLE AND MEDINPUR 28 28 RABINDRANATH MANNA M 45 MEDINPUR WB Nil Distribution PAC-40 , WEST confirmed 13.01.2021 BENGAL 13.01.2021 8348848495 AT JOTEKANUNANGARH PS AT GHATAL DIST PACHIM JOTEKANUNANGARH PASCHIM MEDINPUR WB PS GHATAL DIST Working well & MEDINPUR 29 29 BANAMALI MAITY M 45Y PACHIM MEDINPUR X TRICYCLE Nil Distribution , WEST WB confirmed 13.01.2021 BENGAL 13.01.2021 AT GOURA PO GOURA PS AT GOURA PO GOURA DASPUR DIST PASCHIM PS DASPUR DIST PASCHIM MEDINPUR WB PASCHIM MEDINPUR Working well & TRICYCLE AND MEDINPUR 30 30 NIMAI MANNA M 33 WB Nil Distribution PAC-40 , WEST confirmed 13.01.2021 BENGAL 13.01.2021 9647521617 AT FARBAYAR PO SEKANDAY AT FARBAYAR PO PS DASPUR DIST SEKANDAY PS DASPUR PASCHIM P.MEDINPUR WB DIST P.MEDINPUR WB Working well & MEDINPUR 31 31 RADHARGAM PRAMARIK M 30 X TRICYCLE Nil Distribution , WEST confirmed 13.01.2021 BENGAL 13.01.2021 AT NALEINMANUP PO AT NALEINMANUP PO PALASHTARI PS DASPUR DIST PALASHTARI PS PASCHIM PASCHIM MEDINPUR WB DASPUR DIST Working well & MEDINPUR 32 32 ANADI JANA M 70 PASCHIM MEDINPUR TRICYCLE Nil Distribution , WEST WB confirmed 13.01.2021 BENGAL 13.01.2021 9867469113 AT DASPUR PO DASPUR PS AT DASPUR PO PASCHIM MEDINPUR WB DASPUR PS PASCHIM PASCHIM MEDINPUR WB Working well & MEDINPUR 33 33 AVIJIT ADHIRANI M 28 TRICYCLE Nil Distribution , WEST confirmed 13.01.2021 BENGAL 13.01.2021 9641554867 AT MAHANPUR PO PASCHIM AT MAHANPUR PO MEDINPUR WB PASCHIM MEDINPUR PASCHIM WB Working well & MEDINPUR 34 34 PUTUL BIASHAI F 22Y TRICYCLE Nil Distribution , WEST confirmed 13.01.2021 BENGAL 13.01.2021 9733776703 AT DARSABHATHA PO AT DARSABHATHA PO NARAYAN CHALK PS DASPUR NARAYAN CHALK PS PASCHIM DIST WEST MEDINPUR WB DASPUR DIST WEST Working well & JITENDRA CHAKRA MEDINPUR 35 35 M 47 MEDINPUR WB TRICYCLE Nil Distribution BANTY , WEST confirmed 13.01.2021 BENGAL 13.01.2021 9932605493 AT LOKANCHALK PO GOURA AT LOKANCHALK PO PS DASPUR DIST WEST GOURA PS DASPUR PASCHIM MEDINPUR WB DIST WEST MEDINPUR Working well & MEDINPUR 36 36 ANIL MONDAL M 39Y WB TRICYCLE Nil Distribution , WEST confirmed 13.01.2021 BENGAL 13.01.2021 9933484612 AT K .
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