Form -3 APPLICATION FORM FOR GRANT OF SUBSIDY TO THE REGISTERED FISHERIES COOPERATIVE SOCIETIES / TRIBAL COOPERATIVE SOCIETIES FOR PROCUREMENT OF FISH TRANSPORT VEHICLE / DEEP FREEZER / THREE WHEELER ( CYCLE RICKSAW ) 1. Name and address of fishermen / tribal Coop.society ( enclosed copy of certificate of registration of the society & resolution of the general body for subsidy). 2. Permanent address 3. Address for communication 4. Fishing License No. ANF / ANB / 5. Duration of fishing in A&N Islands 6. Whether fishing license for the current year renewed. 7. Whether applicant / fishermen / Tribal coop.societies possess fishing and dinghy license for the three consecutive years (including current year) 8. In case of Tribal applicant / cooperative societies possess fishing & dinghy license for two consecutive year (including current year ) 9. Whether the applicant / fishermen / Tribal coop.societies was allotted Fish Transport Vehicle / Deep Freezer / Three Wheeler (Cycle Ricksaw) by the Deptt.of Fisheries during the last eight years. 10. If allotted, the details thereof. 11. The source from which the balance amount for meeting the expenditure towards purchase of Fish Transport Vehicle / Deep Freezer / Cycle Ricksaw will be arranged. Certified that the informations furnished above is true to the best of my knowledge and belief and I shall be personally responsible if any part of the information is found incorrect. Place : Date : Signature of the Applicant Recommendation of the members of the respective Panchayati Raj Institution / Counselor of Municipal Ward (with name, signature, seal and date ) In case of Fisheries/Tribal Coop. Societies recommendation of A&N Fisheries Coop. Federation Ltd (with name, signature, seal and date ) For Office Use Only 1. Date of receipt of application 2. Field verification report and specific recommendation of the Officer Incharge (with signature, date and seal ) 3. Recommendation of Zonal Officer Incharge (with signature, date and seal ) For use in the Directorate of Fisheries
