Form No. 4 APPLICATION FORM FOR SUPPLY OF INBOARD / OUTBOARD ENGINE ON SUBSIDY TO FISHERMEN/ TRIBES 1. Name of the Applicant : 2. Father 's name : 3. Permanent address : 4. Address for communication : 5. Fishing license No. : ANF / ANB / 6. Duration of fishing in A&N Islands ; 7. Whether fishing license for the current ; year renewed 8. Whether applicant posses fishing and : dinghy license for the three consecutive years (including current year ) 9. In case of tribes applicant possess ; fishing and dinghy license for the two consecutive years (including current year) 10.Size of the dinghy / boat (length, : breadth , depth ) 11. Whether motorized or non-motorised : 12. Whether the applicant is a member of : any fishermen coop. society. 13.Whether the applicant has allotted : inboard / outboard engine by the Deptt. of Fisheries / any other department during last five years. 14. If allotted, the details thereof : 15. The source from which the balance amount: for meeting the expenditure towards purchase of engine will be arranged. Certified that the information's 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 in correct. Place ; Date : Signature of the 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 In-charge (with signature, date and seal ) 4. For use in the Directorate of Fisheries.
