Form No.8(A) ANDAMAN AND NICOBAR ADMINISTRATION DIRECTORATE OF FISHERIES * * * * APPLICATION FORM FOR RENOVATION OF HOUSES OF MARINE FISHERMEN 1. Name, Father's name, age of the applicant : 2. Permanent Address : 3. Address for communication : 4. Details of fishing licence for the last ten years including current year : Year ANB ANF 5. Owner of the land and house, No., Place panchayat/ Municipal Ward (copy of land holding record and Survey map to be enclosed). : 6. Year of construction of house : 7. Total Annual income of the family including the applicant (Certificate from the Pradhan of the respective Panchayat/ Patwari/ Ward Councillor to be produced). a) Whether belongs to BPL (copy of Certificate to be produced) 8. Whether Married and Staying with family Yes No 8. (a) Family Particulars S.No. Name Male/ female Relation with HOF Age Occupation Annual Income (Rs.) 9. (a) Whether availed any loan from Fisheries Department under any scheme earlier : (b) If so details thereof (c) Whether any dues outstanding against the applicant to the department with details 10. Whether a fishermen settler/ any other settler (Enclosed copy of Certificate) : 11. Present status of accommoda- : tion( mark the applicable item) Katcha Semi-pucca Pucca Nature of finance if any availed for construction of existing residential accommodation. : (a) From bank / Govt. deptt., at the time of construction of house. : Rs.__________________ (b) Details of outstanding dues/ interest if any for 9 (a) above. : Rs.__________________ 12. Total plinth area of the house (In Sq. mts) : 13. Details of renovation proposed (Item wise, cost to be furnished) : 14. Source of finance (i) Applicant contribution : Rs..................................... (ii) Bank Loan if any : Rs........................................ (iiii) Grant from Fisheries Deptt. : Rs.................................... Certified that the information 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 to be incorrect. Place : Date : Signature / LTI of Applicant Recommendation of the members of the respective Panchayati Raj Institution/Councillor of Municipal Ward with Certificate Certified that I know personally Shri...............S/o.......... ...................R/o ............village for the last.... years and his main source of income is from fishing. The total annual income of Shri............ and his family is Rs....... (Rupees....................only). He and his family belongs / not belong / to Below Poverty Line. He may be considered for benefits under the programme (Name, Signature and Seal) Panchayat / ward Place Date For Office Use Only 1. Date of receipt of application 2. Field verification report and specific recommendation of the Officer In-charge of the respective area. (Use separate sheet incase the space provided is not sufficient) (Name, signature, date and seal) 3. Recommendation of Zonal Officer In-charge with special reference to item no. 9 (Use separate sheet incase the space provided is not sufficient) (Name, signature, date and seal) For use in the Directorate of Fisheries
