Form No. 5 ANDAMAN AND NICOBAR ADMINISTRATION DIRECTORATE OF FISHERIES * * * * APPLICATION FORM FOR FINANCIAL ASSISTANCE FOR RENOVATION OF FRESH WATER FISH PONDS 1) Name of applicant (in block letters) : 2) Father's name : 3) Permanent address : 4) Address for communication : 5) Locality of the existing pond : 6) Survey No./ Plot No. in which the pond is located. (Certified copies of documents from the Revenue Authority showing the pond belong to the applicant) : 7) Year of construction of pond : 8) When the pond was last renovated : 9) Amount spent during the last excavation : 10) The size of the existing pond : (a) Length : ....................... (b) Breadth : ....................... (c) Depth : ....................... 11) Depth of water in the pond : (i) during Rain : ............... (ii) During summer : ............... 12) Nature of soil in the tank bed (Sandy, Clay, Stony etc.) : 13) Weeds present in the pond : 14) No. of inlet & outlet for entry and exit of water from the pond and how it is being controlled : 15) If, used for fish culture, types of fishes being cultured : 16) Any other use of the pond : 17) When the pond was stocked with fish seed (State the date of stocking, numbers stocked species wise) : 18) How the pond will be used after the proposed renovation : 19) The detail of plan estimate for renovation work : 20) The agency for renovation. If local labourers are available the number of labourers proposed to be availed at a time and present rate of earth work in the locality (Rs.) : 21) The minimum time required (days) to complete the work : 22) Whether any financial assistance was availed during any previous years and, if so indicate the year and fund availed : Year : ....................... Rs. : .......................... 23) Whether the applicant is a defaulter to any other department, if so furnish details : Certified that the information furnished above is true to the best my knowledge and belief and I shall be personally responsible, if any part of the information is found incorrect. Place : Dated : Signature of the Applicant Recommendation of the members of the respective Panchayati Raj Institution/Counsellor of Municipal Ward (with name, signature, seal and date) For Office Use Only (i) Date of receipt of application (ii) Field verification report and specific recommendation of the Officer In-charge (with signature, date and seal) (iii) Recommendation of Zonal Officer In-charge (with signature, date and seal) (iv) For use in the Directorate of Fisheries
