Form No.8(B) Andaman and Nicobar Administration Directorate of Fisheries * * * * APPLICATION FORM FOR REPLACEMENT OF ROOF / THATCHING OF ROOF 1. Name, Father's name, age of the applicant : 2. Permanent Address : 3. Address for communication : 4. Details of fishing licence in case of fishermen 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 or any other settler : 11. Present status of accommoda- : tion( mark the applicable item) Katcha Semi-pucca Pucca 12. Material used for the thatching the existing house ( mark the applicable item 13, Material proposed to be used for replacement of roof / thatching of roof ( mark the applicable item 14. Total plinth area of the house (In Sq. mts) : 15. 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 at a later date 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
