A P STATE MINORITIES FINANCE CORPORATION LIMITED APPLICATION FOR FINANCIAL ASSISTANCE TO SELF- HELP GROUPS Registration No: Date: Group Name: Address: Door No. Land Mark reet St Ward/Village City/Municipality/Mandal District Constituency Contact Phone No.: Date of Formation: Total Members: Monthly Thrift of a Member: Rs. Total Thrift: Rs. Present Bank Balance: Rs. Bank A/c No.: Bank & Branch Name: President Name: Secretary Name: Revolving Fund availed: Yes No If Yes, Specify Date: Micro Credit availed: Yes No If Yes, specify amount: Rs. Date: Credit Proposal Submitted for 1st Phase: 2ndPhase: 3rd Phase: Micro Credit. Total Group Credit Required: Rs. Bank Loan: Rs. Group Contribution: Rs. Participated Bank Branch Name: Place: Date: Secretary Signature President Signature (With Seal) (With Seal) Note: The beneficiary shall be contribute 10% of the Unit cost and the APSMFC will provide Subsidy @ 50% of the Unit cost, Subject to a maximum limit of Rs. 30,000/-. Required Enclosures: Self declaration of annual income along with Xerox copy of ration card OR Income certificate by Tahasildar. One passport size photo graph attested by MPDO / Related Bank Branch Manager. Enclosures of Each Individual Member: Name: ___________________________________________________________ W/o/D/o: ____________________________________________ Age: _____, bBelongs to belongs to Muslim/ Christian / Sikh / Buddhist / parsi, community is being one of the Member of ______________________________________ Group and requested to sanction Micro credit. (Member Signature) SELF DECLARATION OF INCOME I, (the above Applicant) hereby declared that my family income per annum from all sources is Rs._______ in words (Rupees ____________________________________________). Also enclosed my Ration Card No. ______________ issued in the year _________ with annual income Rs. __________. Place : Date : Signature of Applicant OR INCOME CERTIFICATE (To be certified by Tahasildar) This is to certify that Sri/Smt/Kum. _________________________________________ S/o. D/o, W/o_________________________________________ R/o _____________________________ His/Her family annual income is Rs. __________ in words (Rupees ___________________ ______________________) Place : Date : Signature of Tahasildar (With Seal) Recent Passport Photo Attested by MPDO/Bank Manager
