ANNEXURE - XII

APPLICATION FOR AVAILING FINANCE UNDER RURAL EMPLOYMENT GENERATION PROGRAMME/MARGIN MONEY SCHEME OF K.V.I.V. BY THE EDUCATED UN-EMPLOYED PERSONS/INDIVIDUAL ARTISANS THROUGH SCHEDULED COMMERCIAL BANKS.

1.       (a)      Name of the beneficiary       :

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

2.       Address in detail.

         (a)         Present Address              :        At   :

                                                                                    P.o. :

                                                                                    Dist.:

         (b)      Permanent Address    :                    At    :

                                                                                    P.O. :

                                                                                    Dist.:

3.       Age and Date of birth (with its proof)         :

4.       Whether he/she belongs to - SC/ST/OBC/

          Women/PH//Ex-Servicemen/MC.

5.       Eductional Qualification(with proof)         :  General                         Technical

6.       Training/Experience(With proof)               :

7.       Name of the project/scheme            :

         intends to set-up.

         Loan Amount : C.E. Rs.

                  W.C.Rs.

                  Total Rs.

       (a) Whether the applicant has availed

            loan under K.V.I. prog./Other prog.

8.       Whether Scheme/Project report submitted    :

9.       Location of the unit   :                 At   :

         (with detail address)                     P.O.:

                                                      G.P.:

                                                      Dist.:

10.     Kind of security proposed to be given? (If Land)     :        Khata No.      Plot No.

                           Area.   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 Bank along with the Project Report

        for financing the project                   :

13.     Documents to be enclosed (in duplicate)      :

(a)                  Passport sizze Phot 2 Nos.

(b)                 Copy of Certificates in support of age.

(c)                  Copy of Project Report.

(d)                 Copy of Caste Certificate where applicable.

(e)                  Land particulars.

(f)                   Other related documents if any, in duplicate.

Remarks and Recommendation of I.P.O.                                        Signature of the Applicant

Remarks and Recommendation of D.C.I.O.

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