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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: MANIPUR District: IMPHAL 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 C/O N. INGOCHA SINGH AT C/O N. INGOCHA PUKHAO PO IMPHAL PS SINGH AT PUKHAO PO IMPHAL DIST IMPHAL WEST IMPHAL PS IMPHAL Working well & IMPHAL, 1 1 NAOREM BEMMA DEVI MANIPUR F 19Y DIST IMPHAL WEST X SMART PHONE Nil Distribution MANIPUR MANIPUR confirmed 15.12.2020 16.12.2020 C/O MAIBAM SANJOY SINGH C/O MAIBAM SANJOY AT THANGJINA IMPHAL DIST SINGH AT THANGJINA IMPHAL WEST MANIPUR IMPHAL DIST IMPHAL Working well & SMART CANE & IMPHAL, 2 2 MAHIBAM PREETY DEVI F 16Y WEST MANIPUR Nil Distribution SMART PHONE MANIPUR confirmed 15.12.2020 9615432561 16.12.2021 AT NAMBOL PO BISHNUPUR AT NAMBOL PO PS BISHNUPUR DIST BISHNUPUR PS BISHNUPUR STATE MANIPUR BISHNUPUR DIST Working well & THOKCHOM JOHNSON IMPHAL, 3 3 M 29Y BISHNUPUR STATE SMART PHONE Nil Distribution SINGH MANIPUR MANIPUR confirmed 15.12.2020 9856699004 16.12.2022 AT OINAM SHAWOMBONG AT OINAM PO IMPHAL DIST IMPHAL SHAWOMBONG PO WEST STATE MANIPUR IMPHAL DIST IMPHAL Working well & KHULAKDAM RABINA IMPHAL, 4 4 F 21Y WEST STATE SMART PHONE Nil Distribution DEVI MANIPUR MANIPUR confirmed 15.12.2020 9862660332 16.12.2023 AT KEISHANTHONG PO AT KEISHANTHONG IMPHAL PS IMPHAL DIST PO IMPHAL PS IMPHAL WEST STATE IMPHAL DIST IMPHAL Working well & SMART CANE & IMPHAL, 5 5 HEISHNAM HERINA DEVI MANIPUR F 13Y WEST STATE Nil Distribution SMART PHONE MANIPUR MANIPUR confirmed 15.12.2020 8729852203 16.12.2024 AT KUMBI PO BISHNUPUR PS AT KUMBI PO BISHNUPUR DIST BISHNUPUR PS BISHNUPUR STATE MANIPUR BISHNUPUR DIST Working well & NONGMAITHEM IBOTON SMART CANE & IMPHAL, 6 6 M 50Y BISHNUPUR STATE Nil Distribution SINGH SMART PHONE MANIPUR MANIPUR confirmed 15.12.2020 8837497842 16.12.2025 AT BISHNUPUR PO AT BISHNUPUR PO BISHNUPUR PS BISHNUPUR BISHNUPUR PS DIST BISHNUPUR STATE BISHNUPUR DIST Working well & KHWARAIPAM SMART CANE & IMPHAL, 7 7 MANIPUR M 20Y BISHNUPUR STATE Nil Distribution JOYKUMAR SINGH SMART PHONE MANIPUR MANIPUR confirmed 15.12.2020 6009389458 16.12.2026 AT PURUM PO CHANDEL PS AT PURUM PO CHANDEL DIST CHANDEL CHANDEL PS STATE MANIPUR CHANDEL DIST Working well & IMPHAL, 8 8 Y SHUNGREI CHOTHE M 26Y CHANDEL STATE SMART PONE Nil Distribution MANIPUR MANIPUR confirmed 15.12.2020 9612205970 16.12.2027 AT SINGGAMEI PO IMPHAL AT SINGGAMEI PO PS IMPHAL DIST IMPHAL IMPHAL PS IMPHAL WEST STATE MANIPUR DIST IMPHAL WEST Working well & IMPHAL, 9 9 ASHEM THOIBI DEVI F 38Y STATE MANIPUR SMART PONE Nil Distribution MANIPUR confirmed 15.12.2020 8415934515 16.12.2028 AT THOUBAL PO THOUBAL AT THOUBAL PO PS THOUBAL DIST THOUBAL THOUBAL PS STATE MANIPUR THOUBAL DIST Working well & IMPHAL, 10 10 ASEM KIRANBALA DEVI F 19Y THOUBAL STATE SMART PONE Nil Distribution MANIPUR MANIPUR confirmed 15.12.2020 8837209932 16.12.2029 AT URIPOK IMPHAL PS AT URIPOK IMPHAL PS IMPHAL DIST IMPHAL STATE IMPHAL DIST IMPHAL MANIPUR STATE MANIPUR Working well & PEBAM GOBINCHAND IMPHAL, 11 11 M 37Y SMART PONE Nil Distribution SINGH MANIPUR confirmed 15.12.2020 9856335178 16.12.2030 AT KHERGAON PO JHOUBAL AT KHERGAON PO PS THOUBAL DIST THOUBAL JHOUBAL PS THOUBAL DIST THOUBAL Working well & IMPHAL, 12 12 RENGBAM SADANA DEVI F 20Y SMART PONE Nil Distribution MANIPUR confirmed 15.12.2020 6009421922 16.12.2031 AT URIPOK PO IMPHAL PS AT URIPOK PO IMPHAL DIST IMPHAL WEST IMPHAL PS IMPHAL STATE MANIPUR DIST IMPHAL WEST Working well & SORAISHAM SMART PHONE IMPHAL, 13 13 F 35Y STATE MANIPUR Nil Distribution SHANTIBALA DEVI AND DAISY PLAYER MANIPUR confirmed 15.12.2020 9856335178 16.12.2032 AT LILONG PO LILONG PS AT LILONG PO LILONG LILONG DIST THOUBAL PS LILONG DIST STATE MANIPUR THOUBAL STATE Working well & IMPHAL, 14 14 RENU BEBI F 19Y MANIPUR SMART PHONE Nil Distribution MANIPUR confirmed 15.12.2020 8.9548E+11 16.12.2033 AT WANGOI PO/PS WANGOI AT WANGOI PO/PS DIST IMPHAL WEST STATE WANGOI DIST IMPHAL MANIPUR WEST STATE Working well & IMPHAL, 15 15 LEILA BEBE F 18Y MANIPUR SMART CANE Nil Distribution MANIPUR confirmed 15.12.2020 9774542087 16.12.2034 AT THOUBAL PS THOUBAL AT THOUBAL PS DIST THOUBAL DIST THOUBAL DIST THOUBAL STATE MANIPUR THOUBAL DIST Working well & SUKHAM BIDYARANI SMART PHONE IMPHAL, 16 16 M 21Y THOUBAL STATE Nil Distribution DEVI AND SAMRT CANE MANIPUR MANIPUR confirmed 15.12.2020 8413884339 16.12.2035 AT THOUBAL PO THOUBAL AT THOUBAL PO DIST THOUBAL STATE THOUBAL DIST MANIPUR THOUBAL STATE Working well & IMPHAL, 17 17 LEIBAKLEI F 21Y MANIPUR SMART PHONE Nil Distribution MANIPUR confirmed 15.12.2020 6009108658 16.12.2036 AT IMPHAL PO IMPHAL PS AT IMPHAL PO IMPHAL DIST IMPHAL EAST IMPHAL PS IMPHAL STATE MANIPUR DIST IMPHAL EAST Working well & SMART PHONE IMPHAL, 18 18 KABIYA KHATUN F 39Y STATE MANIPUR Nil Distribution AND SMART CANE MANIPUR confirmed 15.12.2020 9774076327 16.12.2037 AT C1 PO IMPHAL PS IMPHAL AT C1 PO IMPHAL PS DIST IMPHAL WEST IMPHAL DIST IMPHAL MANIPUR WEST MANIPUR Working well & IMPHAL, 19 19 MANAUIKA AKHAM F 19Y SMART PHONE Nil Distribution MANIPUR confirmed 15.12.2020 7005202070 16.12.2038 AT/PO MOIRANG PS AT/PO MOIRANG PS MOIRANG DIST BISHNUPUR MOIRANG DIST STATE MANIPUR BISHNUPUR STATE Working well & LAIPURAKPAM SMART CANE AND IMPHAL, 20 20 M 16Y MANIPUR Nil Distribution BISHESWOR SINGH DAISY PLAYER MANIPUR confirmed 15.12.2020 8913869330 16.12.2039 AT JAMJONG PO YAINEPOK AT JAMJONG PO PS KASHOM DIST KAMJONG YAINEPOK PS MANIPUR KASHOM DIST Working well & SMART CANE AND IMPHAL, 21 21 N. HUNGCHING LENG M 12Y KAMJONG MANIPUR Nil Distribution DAISY PLAYER MANIPUR 16.12.20 confirmed 9863126719 16.12.2040 AT LAMSHANG PO AT LAMSHANG PO LAMSHANG PS LAUNHANG LAMSHANG PS DIST IMPHAL WEST LAUNHANG DIST Working well & THOKCHOM RANJAN IMPHAL, 22 22 MANIPUR M 27Y IMPHAL WEST DAISY PLAYER Nil Distribution SINGH MANIPUR MANIPUR 16.12.20 confirmed 9612352330 16.12.2041 AT NGAIRANGBAM DIST AT NGAIRANGBAM IMPHAL WEST MANIPUR DIST IMPHAL WEST MANIPUR Working well & MAYENGBAM NADBA SMART PHONE IMPHAL, 23 23 M 19Y Nil Distribution SINGH AND SMART CANE MANIPUR 16.12.20 confirmed 6009072997 16.12.2042 AT KHARAMPAOLINE PO AT KHARAMPAOLINE LANGJIRG PS SUPHAREEINA PO LANGJIRG PS DIST KANGPOKPI MANIPUR SUPHAREEINA DIST Working well & SMART PHONE IMPHAL, 24 24 JAICHE ROBEN M 18Y KANGPOKPI MANIPUR Nil Distribution AND SMART CANE MANIPUR 16.12.20 confirmed 9612475920 16.12.2043 AT K.LESHAORAM PO AT K.LESHAORAM PO YAIRIPOK PS YAIRIPOK DIST YAIRIPOK PS YAIRIPOK KAMZORG STATE MANIPUR DIST KAMZORG STATE Working well & IMPHAL, 25 25 HAPPYSON HUNGYO M 24Y MANIPUR SMART PHONE Nil Distribution MANIPUR 16.12.20 confirmed 8787449569 16.12.2044 AT SANTING PO MOTBURG AT SANTING PO PS SAPARMEINA DIST MOTBURG PS SENAPATI MANIPUR SAPARMEINA DIST Working well & IMPHAL, 26 26 LELET HAOKIP M 25Y SENAPATI MANIPUR SMART PHONE Nil Distribution MANIPUR 16.12.20 confirmed 7085647792 16.12.2045 AT SAIKUL PO SAIKUL DIST AT SAIKUL PO SAIKUL KANGPOKPI MANIPUR DIST KANGPOKPI MANIPUR Working well & LMANGPELUN IMPHAL, 27 27 M 18Y SMART PHONE Nil Distribution CHONGLOI MANIPUR 16.12.20 confirmed 8415806161 16.12.2046 AT HAILAKANTI DIST ASSAM AT HAILAKANTI DIST STATE MANIPUR ASSAM STATE MANIPUR Working well & HIJAM KIRANKUMAR IMPHAL, 28 28 M 24Y SMART PHONE Nil Distribution SINGH MANIPUR 16.12.20 confirmed 8638399169 16.12.2047 THOUBAL PO THOUBAL PS THOUBAL PO THOUBAL DIST THOUBAL THOUBAL PS MANIPUR THOUBAL DIST Working well & SMART PHONE IMPHAL, 29 29 MANJUR HUSSAN M 15Y THOUBAL MANIPUR Nil Distribution AND DAISY PLAYER MANIPUR 16.12.20 confirmed 6909007172 16.12.2048 AT ANDRO PO YAINEPOK PS AT ANDRO PO ANDRO DIST IMPHAL EAST YAINEPOK PS ANDRO MANIPUR DIST IMPHAL EAST Working well & PUTHEM MANDIKINI IMPHAL, 30 30 F 17Y MANIPUR SMART PHONE Nil Distribution DEVI MANIPUR 16.12.20 confirmed 7085407132 16.12.2049 AT THANGA PO MOINANG PS AT THANGA PO KUBUL DIST BISHNUPUR MOINANG PS KUBUL MANIPUR DIST BISHNUPUR Working well & SMART PHONE IMPHAL, 31 31 HEISNAM KUMAR SINGH M 26Y MANIPUR Nil Distribution AND SMART CANE MANIPUR 16.12.20 confirmed 9366281873 16.12.2050 AT NOUGMAIKHONG PO AT NOUGMAIKHONG MOISRANG PS KEIBUL PO MOISRANG PS MANIPUR KEIBUL MANIPUR Working well & HAOBIJAM MANGI SMART PHONE IMPHAL, 32 32 M 20Y Nil Distribution SINGH AND SMART CANE MANIPUR 16.12.20 confirmed 8119978115 16.12.2051 AT PANGEI PO HEINGANG AT PANGEI PO DIST HENGANG MANIPUR HEINGANG DIST HENGANG MANIPUR Working well & IMPHAL, 33 33 R.K. KIYAMBA MEITEI M 38Y SMART PHONE Nil Distribution MANIPUR 16.12.20 confirmed 9856669989 16.12.2052 AT OINAM PO NAMBOL PS AT OINAM PO NAMBOL DIST BISHNUPUR NAMBOL PS NAMBOL MANIPUR DIST BISHNUPUR Working well & IMPHAL, 34 34 OINAM THOITHOI DEVI F 32Y MANIPUR SMART PHONE Nil Distribution MANIPUR 16.12.20 confirmed 9402881817 16.12.2053 AT SINAM MAYAI LUIKAI PO AT SINAM MAYAI PANGEI DIST IMPHAL EAST LUIKAI PO PANGEI MANIPUR DIST IMPHAL EAST Working well & IMPHAL, 35 35 ARUBAM RANJANA DEVI F 43Y MANIPUR SMART PHONE Nil Distribution MANIPUR 16.12.20 confirmed 9402881817 16.12.2054 AT NAMBOL PO NAMBOL AT NAMBOL PO DIST BISHNUPUR MANIPUR NAMBOL DIST BISHNUPUR MANIPUR Working well & THANGJAM THOITHOIBA IMPHAL, 36 36 M 20Y X SMART PHONE Nil Distribution SINGH MANIPUR 16.12.20 confirmed
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