ANNEXURE - X

APPLICATION FOR THE AVAILING FINANCE UNDER SPECIAL EMPLOYMENT PROGRAMME OF ORISSA KHADI & VILLAGE INDUSTRIES BOARD, BHUBANESWAR.

1.       (a)      Name of the beneficiary       :

         (b)      Father's/Husband's   Name    :

2.       Address in detail                         :

         (a)      Present Address                                  (b)      Permanent Address :

3.       Age & Date of birth with its proof    :

4.       Whether he/she belong to SC/ST/OBC/

      Women/P.H./Ex-SER./M.C./GENERAL/

         TECHNICAL.                                    :

5.       educational Qualification(with proof).         :

6.       Training/Experience(with proof) if any        :

7.       Name of the Scheme/Project intends to Set-up

         Loan Amount -        C.E. Rs.       

                           W.C.Rs.

                           Total Rs.

(a)     Whether  the applicant has availed

       loan under KVI   programme/Other

       programme.             :

8.       Whether Scheme/Project report submitted    :

9.       Location of the Unit (with detail address)    :

10.     Kind of security proposed to be given-

         If Land-        Khata No:               Plot No:        Mouza:

11.     Name of the Nationalised Bank Branch

       (service area) of proposed venture to be located:

12.     Whether the applicant contacted the bank and

       discussed with them alongwith the project

       report for financing the project:      :

13.     Documents to be enclosed :

(a)                  Passport size photo 2nos.

(b)                 Copy of certificate in support of age, qualification etc.

(c)                  Copy of Project Report.

(d)                 Copy of Caste Certificate, where applicable.

(e)                  Land particulars.

(f)                   Other related documents, (if any)

Remark/Reommendation of I.P.O.

Signature of the Applicant.

Remark/Recommendation of the D.C.I.O

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