Physical Verification Form for NSP

(IRCS Phase-1)
Application No. _______________________________________ Visit Date: ___________________________________

Cancelled Site Details

Cancelled Site Code: ________________________________________ Cancelled School Code: __________________________________________________________

Name of School: ______________________________________________ Address of Cancelled School: ___________________________________________________

GIS Coordinates: Latitude:____________________________Longitude:___________________________

Basic School Information

Category ( Applied for): PEF Partner for Campus ⎕ Private Functional School ⎕ Private Non-Functional School⎕
NGO For Campus ⎕ NGO for New School⎕

Proposed SchoolName:

Proposed School Address: Basti/Village: _______________________________________ Moza/Chak:____________________________________

UC No. _____________ UC Name ________________________________ Tehsil &District:_____________________________________________________

Proposed Building Coordinates(Minimum 6 digits after decimal point): Latitude_________________ Longitude________________

Location of school: Urban ⎕ Rural ⎕ Slum ⎕

School owner/Applicant Name: CNIC #: Contact No:

School owner/Applicant Academic Qualification: School owner Professional Qualification:

School owner/applicant resident of same tehsil of proposed site: Yes⎕ No ⎕ If no, name of tehsil __________________

Already PEF Partner: Yes No Remained PEF partner in past: Yes No

(required from Private Applicant)
If yes, Program Name: FAS NSP EVS Period: ________________ PEF School Code: ________________
Reason for cancellation: _________________________________________________________________________________________________

School Principal/Representative: CNIC #: Contact No:

In case of NGO (Write name of NGO):

Type of ownership: Single ⎕ Partnership⎕ Proof in-case of partnership: Yes ⎕ No ⎕

(Mark only if proof is available)
If Yes, Detail: ____________________________________________________________________________________________________________________________________________

Name of Partner: __________________________________________________________ CNIC # _______________________________ Contact # ______________________

_______________________________________________________________________________________________________
Postal Address
for mail _______________________________________________________________________________________________________

Proposed School/Campus Information

Monitor Name (1) __________________________ Designation & Dept. __________________Signature ____________

Monitor Name (2) __________________________ Designation & Dept. __________________ Signature ____________

School Owner Name _____________________________ Signature _______________________

Page 1 of 7
S.# Descriptions Details
Total Rooms: ________________________Total Class Rooms: ________________________
No. of proper rooms (with 3 walls) _________________
No. of improper rooms (<3walls/passage/No roof) _______________________
Infrastructure &
1 Principal Office: Yes ⎕ No ⎕Staff room Office: Yes ⎕ No ⎕
facilities
No. of Toilets for students: ________________ No. of Toilets for Teachers: ____________
Total No of toilets:____________________________________
Total Water Points: __________________ No. of campuses: __________________

Total:_______________________ Marlas, Covered area: _______________________ Marlas

2 School Area:
Play Ground: Yes ⎕ No ⎕

3 Building Ownership 1. Owned ⎕2. Family owned ⎕ 3. Rented ⎕4. Shamlat⎕5. Donated ⎕(Attach Photocopy)

Classroom condition: Mud Constructed ⎕ Brick constructed ⎕Plastering: Yes ⎕No ⎕

Boundary Wall: Yes ⎕No ⎕Science Lab: Yes ⎕ No ⎕ Computer Lab: Yes ⎕No ⎕
4
Library: Yes ⎕ No ⎕Roof condition: Concrete (RCC) ⎕ TR Girder ⎕ Reeds ⎕
Electricity: Yes ⎕ No ⎕Door & Windows: Yes ⎕ No ⎕ Partial⎕

Establishment
5
Status: Date of Establishment ____________________ (As per applied for documents for school registration)

Registered: Yes ⎕No⎕ If Yes, Registration No. _________________________

Date of Registration: ____________________Date of Expiry: ____________________________
If applied for registration then: Fee Submission through: E-Challan ⎕ 32-A Challan ⎕
Fee submission Date: ________________ Date of SRC submission Case to DRA: ___________________
Mention Name in whom school is registered/Applied For: ____________________________

Registration &
6
School Level: Level of School (as per registration): Primary ⎕ Middle ⎕ Secondary ⎕ H. Secondary ⎕
Level of School (as per existing classes): Primary ⎕ Middle ⎕ Secondary ⎕ H. Secondary ⎕

Type of School(as per existing classes):Boys ⎕ Girls ⎕ Co-education ⎕

Type of School (as per registration): Boys ⎕ Girls ⎕ Co-education ⎕

Monitor Name (1) __________________________ Designation & Dept. __________________Signature ____________

Monitor Name (2) __________________________ Designation & Dept. __________________ Signature ____________

School Owner Name _____________________________ Signature _______________________

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 Class-Wise Enrollment
9 9 10 10
Classes N P 1 2 3 4 5 6 7 8 Total
Arts Sci Arts Sci

No ofSections

Students (Boys)

Students (Girls)

Total Students

Present(Boys)

Present(Girls)

No. of Present
Students

Fee Structure:

Furniture (No. of
seats)

Capacity

Medium of
instructions
(Urdu/ English)
School Record

Students’ Attendance Register: Yes ⎕No⎕ Admission Withdrawal Register: Yes ⎕No⎕
Teacher’s Salary Register: Yes ⎕No⎕ Teacher Attendance Register: Yes ⎕No⎕
Building Fitness Certificate: Yes ⎕No⎕ Health & Hygiene Certificate: Yes ⎕No⎕
Attach Photocopies of Building Fitness and Health & Hygiene Certificates (in case of Yes)

Teachers Detail
Sr. Teacher Teacher Teacher Teaching Class taught
# Teacher Name Salary Academic Professional Experience in school
Qualification Qualification (in months)

Monitor Name (1) __________________________ Designation & Dept. __________________Signature ____________

Monitor Name (2) __________________________ Designation & Dept. __________________ Signature ____________

School Owner Name _____________________________ Signature _______________________

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 Detail of BISE Results for Private Applicants Only
School Appeared in BISE Exams 2020-21:Yes⎕ No⎕ No. of Students Appeared: ____________ Affiliation: Yes⎕ No ⎕

Detail of BISE Results for NGO Only

Schools Appeared in PEC Exams: Yes⎕ No⎕ Schools Appeared in BISE Exams: Yes⎕ No ⎕

BISE
Session No. of Students
Class No. of Schools Pass Fail
Appeared

9th

10th

Detail of Applicant’ Blood Relatives who are PEF Employee

Sr. # Name of Relative Father’s Name Relation Program

Monitor Name (1) __________________________ Designation & Dept. __________________Signature ____________

Monitor Name (2) __________________________ Designation & Dept. __________________ Signature ____________

School Owner Name _____________________________ Signature _______________________

Page 4 of 7
 Distance Measurement
 Distance of proposed building/campus from Landmark _____________________________ (In meters).
 Distance of proposed campus from main campus (For PEF-Partner/NGO)________________________(In meters)
 Distance of Main campus from Cancelled Site (For private/PEF Partner/NGO) ______________________ (In meters)
 Availability of PEF/GOVT. schools within 1km radius from proposed campus: Yes⎕ No ⎕ If Yes, give details

Type(Govt./PEF)&Code Distance from proposed Level of Latitude

Name of School Longitude
with Program building (In meters) School

Community References
Name Mobile No. General Remarks on teaching environment

Monitor Name (1) __________________________ Designation & Dept. __________________Signature ____________

Monitor Name (2) __________________________ Designation & Dept. __________________ Signature ____________

School Owner Name _____________________________ Signature _______________________

Page 5 of 7
 Sketch of the school (Please read the instructions)

Proposed
School/Campus

OtherFindings/ Remarks:

__________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

Monitor Name (1) __________________________ Designation & Dept. __________________Signature ____________

Monitor Name (2) __________________________ Designation & Dept. __________________ Signature ____________

School Owner Name _____________________________ Signature _______________________

Page 6 of 7
 ___________________________________________________________________________________________________________________________

SIGNATURE / UNDERTAKING BY SCHOOL OWNER:

I hereby declare that the information provided above is accurate to the best of my knowledge and I fully
understand that my false statement or material omission / suppression of any fact shall reject my
application and shall render me liable to disciplinary/legal action, at any stage.

Name: ______________________________________________ CNIC #: _________________________________

Stamp & Signature ________________________________ Date: ____________________________________

Instructions:

1. Please fill the form carefully.

2. In-case of school/campus is non-functional, then cross the relevant section related to school functionality i.e.
Establishment status, student enrollment section, teachers information section, school record.
3. Mention names of house owners / Plot No. / Shop name etc. located around school building. Also, make a sketch
of the school to show landmark i.e. applicant’s school and nearest schools with their distance(s)
4. Photographs of proposed building and its surroundings.

Monitor Name (1) __________________________ Designation & Dept. __________________Signature ____________

Monitor Name (2) __________________________ Designation & Dept. __________________ Signature ____________

School Owner Name _____________________________ Signature _______________________

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