Form No. 1 APPLICATION FORM FOR PROVIDING SUBSIDY FOR THE PURCHASE / CONSTRUCTION OF MECHANIZED BOATS TO THE FISHERMEN / TRIBES, THEIR COOPERATIVE SOCIETIES/UNEMPLOYED YOUTH/ INETERESTED ENTREPRENEUR 1. Name of Applicant ; 2. Father's name : 3. Permanent Address : 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 possess fishing and dinghy license for the three consecutive year (including current year) 8. In case of tribes applicant possess fishing and dinghy license for two consecutive year (including current year). 9. Whether member of any cooperative society. 10. When the boat is constructed locally : a)Details of construction cost of boat (including materials)along-with the tender obtained by him if any. b) Size of the boat(length,breadth and depth)with blue print of scale drawings. 11. Whether the applicant was allotted any type of mechanized boat by the Department of Fisheries / any other department during last eight years. 12. If allotted, the details thereof 13. The source from which the balance amount for meeting the expenditure towards purchase / construction of boats 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 Applicant Recommendation of the members of the respective Panchayati Raj Institution / Counsellor 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 ). 4. For use in the Directorate of Fisheries
