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 2019-20 Name of the Implementing Agency - SVNIRTAR, Olatpur

PART-I State: ASSAM District: KAMRUP

Sl. Name of Benificiary Father's/Husband Male/ Age Complete Address Contac Type of Aid Place of Camp Date of Date of Test

No. 's name Femal t given Camp Check working

e Numb dertaken

check(e.g. check(e.g. quality not

er distribution

confirmed&

Whether any Whether

coveredBeni.

confirmedbut

Findingof test-

well/distribution

surgicalcorrection Sl. No. of Sl. ofthe list 1 2 3 4 5 6 7 8 9 10 11 12 13 14 VILL-BALIKARIA, VILL-BALIKARIA, DIST-NALBARI, DIST-NALBARI, ASSAM ASSAM DISTRIBUTION BINAURAL CRC, GUWAHATI 1 1 DIYA KASHYAP F 2Y - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

16.11.2019 16.11.2019 8402897141

VILL- VILL- TINTHENGIA,DAUL TINTHENGIA,DAULA ATPUR, P.S- TPUR, P.S-BIHPURIA, DISTRIBUTION BIHPURIA, DIST- DIST-LAKHIMPUR BINAURAL CRC, GUWAHATI 2 2 SHANAYA BEGUM F 4Y - CONFIRMED AND LAKHIMPUR ASSAM HEARING AID (ASSAM)

ASSAM WORKIG WELL

24.01.2020 24.01.2020 8403973172

BASISTHAPUR, BASISTHAPUR, BASISTHAPUR BASISTHAPUR CHARALI, P.S- CHARALI, P.S- DISTRIBUTION BASISTHA, DIST- BASISTHA, DIST- BINAURAL CRC, GUWAHATI 3 3 ANISHA PAUL F 10Y - CONFIRMED AND KAMRUP(M), KAMRUP(M), HEARING AID (ASSAM)

ASSAM ASSAM WORKIG WELL

24.01.2020 24.01.2020 9365270993

1 of 1 BATSOR, P.O- BATSOR, P.O- BATSOR DIST- BATSOR DIST- NALBARI NALBARI DISTRIBUTION BINAURAL CRC, GUWAHATI 4 4 AJGAR ALI M 48Y - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 8011302112

Vill-LATIBARI, Vill-LATIBARI, P.O/P.S- P.O/P.S-TAMULPUR, TAMULPUR, DIST- DIST- BAKSA DISTRIBUTION BAKSA BINAURAL CRC, GUWAHATI 5 5 NIRADA KALITA F 41Y - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 9678830654

VILL- VILL- DUMUNICHOWKI, DUMUNICHOWKI, P.O-MARUA P.O-MARUA DISTRIBUTION CHOWK, P.S- CHOWK, P.S- BINAURAL CRC, GUWAHATI 6 6 AINUL HUSSAIN M 3Y - CONFIRMED AND SHIPAJHAR, DIST- SHIPAJHAR, DIST- HEARING AID (ASSAM)

DARRANG, ASSAM DARRANG, ASSAM WORKIG WELL

24.01.2020 24.01.2020 6001481294

VILL- VILL- PACHANIAPARA, PACHANIAPARA, P.O-BONGRA, P.S- P.O-BONGRA, P.S- DISTRIBUTION AZARA, DIST- AZARA, DIST- BINAURAL CRC, GUWAHATI 7 7 ANURAG SARMA M 13Y - CONFIRMED AND KAMRUP(M) KAMRUP(M) HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 9954880472

VILL-BAMUDANJA, VILL-BAMUDANJA, P.O-MARKULA, P.S- P.O-MARKULA, P.S- BHUGAN, DIST- BHUGAN, DIST- DISTRIBUTION GOALPARA, ASSAM GOALPARA, ASSAM BINAURAL CRC, GUWAHATI 8 8 AYSHA SIDDIKA F 3Y - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 8761050978

2 of 2 VILL-SILPUTA,P.O- VILL-SILPUTA,P.O- SASTRAPAPA, P.S- SASTRAPAPA, P.S- HARISINGA, DIST- HARISINGA, DIST- DISTRIBUTION UDALGURI(BTAD), UDALGURI(BTAD), BINAURAL CRC, GUWAHATI 9 9 SWARJI BASUMATARI M 4Y - CONFIRMED AND ASSAM ASSAM HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 8473853158

Vill-AOLATABI,P.S- Vill-AOLATABI,P.S- LAKHIPUR, DIST- LAKHIPUR, DIST- GOALPARA, ASSAM GOALPARA, ASSAM DISTRIBUTION BINAURAL CRC, GUWAHATI 10 10 MORIJMA KHATUN F 23Y - - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020

VILL-SALAPARA, VILL-SALAPARA, P.O- P.O-LAKHIPUR, LAKHIPUR, DIST- DIST-GOALPARA, GOALPARA, ASSAM DISTRIBUTION ASSAM BINAURAL CRC, GUWAHATI 11 11 ZAHIDUL ISLAM M 18Y - - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020

VILL-VDAJ NAGAR, VILL-VDAJ NAGAR, P.S-FATASHIL P.S-FATASHIL AMBARI, DIST- AMBARI, DIST- DISTRIBUTION KAMRUP(M), KAMRUP(M), BINAURAL CRC, GUWAHATI 12 12 MANJIT MANDAL M 40Y - CONFIRMED AND ASSAM ASSAM HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 9957329221

VILL-RAUMARI, P.S- VILL-RAUMARI, P.S- LAKHIPUR, LAKHIPUR, GOALPARA, ASSAM GOALPARA, ASSAM DISTRIBUTION BINAURAL CRC, GUWAHATI 13 13 ASMA KHATUN F 42Y - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 9957329221

3 of 3 VILL-BARKHAL, VILL-BARKHAL, SHYAMLATA, P.S- SHYAMLATA, P.S- DHULA, DIST- DHULA, DIST- DISTRIBUTION DARANGA, ASSAM DARANGA, ASSAM BINAURAL CRC, GUWAHATI 14 14 MAFIZUDIN M 50Y - - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020

VILL-KAHIBARI, VILL-KAHIBARI, P.O/P.S- P.O/P.S-HARISINGA, HARISINGA, DIST- DIST-UDALGURI DISTRIBUTION UDALGURI BTAD, BTAD, ASSAM BINAURAL CRC, GUWAHATI 15 15 AKASH BASUMATARI M 3Y - CONFIRMED AND ASSAM HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 8471825448

UGRATARAMANDI UGRATARAMANDIR, R, P.O-UZANBAZAR, P.O-UZANBAZAR, P.S-LATASIL. DIST- P.S-LATASIL. DIST- DISTRIBUTION KAMRUP (M) KAMRUP (M) BINAURAL CRC, GUWAHATI 16 16 JITEN SHARMA M 86Y - CONFIRMED AND HEARING AID (ASSAM)

WORKIG WELL

24.01.2020 24.01.2020 9864075088

4 of 4 5 of 5 Format of Test-Check Report under ADIP Scheme Test Check (Minimum of 10/15 percent*) of beneficiaries assisted during the year 2019-20 Name of the Implementing Agency - SVNIRTAR, Olatpur

PART-I State: ASSAM District: BADARPUR

Sl. Name of Benificiary Father's/Husband Male/ Age Complete Address Contac Type of Aid Place of Camp Date of Date of Test No. 's name Femal t given Camp Check e Numb

coveredBeni.

Sl. No. of Sl. ofthe list

noty confirmedetc.

correction dertaken correction

Whether any Whether surgical

satisfactory/distribution

distributionconfirmed &

Finding of test-check(e.g. Findingof test-check(e.g.

workingwell/distribution confirmedbut quality not 1 2 3 4 5 6 7 8 9 10 11 12 13 14 AT SRIMANT PO AT SRIMANT PO DISTRIBUTION SIBAR CHHAK DIST SIBAR CHHAK DIST BINAURAL BADARPUR, 1 1 ABDUL RUFF M 11Y X - CONFIRMED AND

KARIMGANJ KARIMGANJ ASSAM HEARING AID ASSAM 07.02.20 07.02.20 WORKING WELL ASSAM C/O LALU MIA AT C/O LALU MIA AT DISTRIBUTION DRGPUR PO DRGPUR PO BINAURAL BADARPUR, 2 2 ALI HUSSAIN M 9Y - CONFIRMED AND

MORJADKANDI MORJADKANDI DIST HEARING AID ASSAM 07.02.20 DIST KARIRNGARJ KARIRNGARJ ASSAM 07.02.20 WORKING WELL ASSAM 6003517524 C/O DHIRENDRA C/O DHIRENDRA MALAKAR AT/PO MALAKAR AT/PO DISTRIBUTION BINAURAL BADARPUR, 3 3 PALLU MALAKAR BADARPUR GHAT M 42Y BADARPUR GHAT PS - CONFIRMED AND

PS KALIR BAND KALIR BAND DIST HEARING AID ASSAM 07.02.20 07.02.20 WORKING WELL

DIST KARIMAGARJ KARIMAGARJ 7637918039 ASSAM ASSAM C/O C/O DISTRIBUTION RAMACHANDRA RAMACHANDRA BINAURAL BADARPUR, 4 4 BABLI RABI DAS F 14Y - CONFIRMED AND

DAS AT SRIKARA PO DAS AT SRIKARA PO HEARING AID ASSAM 07.02.20 SRIKARA DIST SRIKARA DIST 07.02.20 WORKING WELL CACUAV ASSAM CACUAV ASSAM 9954662671 C/O SAHID C/O SAHID AHAMMAD AT AHAMMAD AT DISTRIBUTION BINAURAL BADARPUR, 5 5 BADAL ISLAM NAYAGRAM PO M 12Y NAYAGRAM PO - CONFIRMED AND

MORYAKARAI DIST MORYAKARAI DIST HEARING AID ASSAM 07.02.20 07.02.20 WORKING WELL

KARIMGARJ ASSAM KARIMGARJ ASSAM 7086215389

C/O MASUK C/O MASUK AHAMAD AT AHAMAD AT DISTRIBUTION BINAURAL BADARPUR, 6 6 SABINA YESMYAN BADCUHAR PO F 4Y BADCUHAR PO - CONFIRMED AND

BANGABAZAR DIST BANGABAZAR DIST HEARING AID ASSAM 07.02.20 07.02.20 WORKING WELL KARIMGANJ KARIMGANJ ASSAM 940120396 ASSAM

6 of 6 C/O HELAL UDDIN C/O HELAL UDDIN AT DAULATPUR PO AT DAULATPUR PO DISTRIBUTION BINAURAL BADARPUR, 7 7 WARIS AHMAD KALIGANJ BAZAR M 11Y KALIGANJ BAZAR - CONFIRMED AND

DIST KARIMGANJ DIST KARIMGANJ HEARING AID ASSAM 07.02.20 07.02.20 WORKING WELL

ASSAM ASSAM 9954517871

C/O LATE PRAVAT C/O LATE PRAVAT CH ROY HALDAR AT CH ROY HALDAR AT DISTRIBUTION BINAURAL BADARPUR, 8 8 SADHAN RAY HALDAR BIHARATHPADA F 59Y BIHARATHPADA - CONFIRMED AND

DIST CACHAR DIST CACHAR HEARING AID ASSAM 07.02.20 07.02.20 WORKING WELL ASSAM ASSAM 690198676

C/O UPENDRA C/O UPENDRA DISTRIBUTION GHOSH AT GHOSH AT BINAURAL BADARPUR, 9 9 POMPI RANI GHOSH F 40Y - CONFIRMED AND

DINONATHH PO DINONATHH PO HEARING AID ASSAM 07.02.20

DINOVATH DIST DINOVATH DIST 07.02.20 WORKING WELL 901115364 CACHAR ASSAM CACHAR ASSAM C/O HALY MIYA AT C/O HALY MIYA AT DISTRIBUTION RONGPUR PO RONGPUR PO BINAURAL BADARPUR, 10 10 MOSTANA BEGUM F 20Y - CONFIRMED AND

MORJADKANDI MORJADKANDI DIST HEARING AID ASSAM 07.02.20 DIST KARIMGANJ KARIMGANJ ASSAM 07.02.20 WORKING WELL ASSAM 6003517524 C/O KUTU MIA AT C/O KUTU MIA AT DISTRIBUTION MAHAKAL PO MAHAKAL PO BINAURAL BADARPUR, 11 11 ABDUL KALAM M 36Y - CONFIRMED AND

MAHAKAL DIST MAHAKAL DIST HEARING AID ASSAM 07.02.20 KARIMGANJ KARIMGANJ ASSAM 07.02.20 WORKING WELL ASSAM 6002378536 C/O MOKHODAS C/O MOKHODAS ALI DISTRIBUTION ALI AT BUNDASHIL AT BUNDASHIL PO BINAURAL BADARPUR, 12 12 SIDDEGUR RAHMAN M 72Y - CONFIRMED AND

PO BADARPUR DIST BADARPUR DIST HEARING AID ASSAM 07.02.20 KARIMGANJ KARIMGANJ ASSAM 07.02.20 WORKING WELL ASSAM 8730056525 C/O MOIN UDDIN C/O MOIN UDDIN DISTRIBUTION AT CHIRIPATHON AT CHIRIPATHON BINAURAL BADARPUR, 13 13 ANWOR HUSSAIN M 10Y - CONFIRMED AND

DIST KARIMGANJ DIST KARIMGANJ HEARING AID ASSAM 07.02.20

ASSAM ASSAM 07.02.20 WORKING WELL 8471929692 C/O STENLY C/O STENLY GANSALVES AT GANSALVES AT DISTRIBUTION BINAURAL BADARPUR, 14 14 RAJA GANSALVES DIGIRPAR PO F 48Y DIGIRPAR PO - CONFIRMED AND

BADALPUR DIST BADALPUR DIST HEARING AID ASSAM 07.02.20 07.02.20 WORKING WELL

KARIMGANJ KARIMGANJ ASSAM 8486844762 ASSAM C/O TELITIKAR PO C/O TELITIKAR PO DISTRIBUTION RAJATILLA DIST RAJATILLA DIST BINAURAL BADARPUR, 15 15 SOMCHIA BEGAM F 09Y - CONFIRMED AND

CHAR ASSAM CHAR ASSAM HEARING AID ASSAM 07.02.20

07.02.20 WORKING WELL 9854458061

7 of 7 C/O ASNAM UDDIN C/O ASNAM UDDIN AT MARJATKANDI AT MARJATKANDI DISTRIBUTION BINAURAL BADARPUR, 16 16 RUBAIYA BEGUM PO MORJAT KANDI M 10Y PO MORJAT KANDI - CONFIRMED AND

DIST KARIMGANJ DIST KARIMGANJ HEARING AID ASSAM 07.02.20 07.02.20 WORKING WELL

ASSAM ASSAM 6000492214

C/O LATE ANIL CH. C/O LATE ANIL CH. DISTRIBUTION DEY AT MASLY PO DEY AT MASLY PO BINAURAL BADARPUR, 17 17 AMITA DEY F 43Y - CONFIRMED AND

BHANGA BAZAR BHANGA BAZAR HEARING AID ASSAM 07.02.20 DIST KARIMGANJ DIST KARIMGANJ 07.02.20 WORKING WELL ASSAM ASSAM 9678026482 C/O SREENAGAR C/O SREENAGAR PO DISTRIBUTION PO BADARPUR DIST BADARPUR DIST BINAURAL BADARPUR, 18 18 SUJIT SAHA M 22Y - CONFIRMED AND

KARIMGARI ASSAM KARIMGARI ASSAM HEARING AID ASSAM 07.02.20

07.02.20 WORKING WELL 6001718388

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