APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTER'S ROJGAR YAJANA FOR EDUCATED UNEMPLOYED YOUTH Photo affix photograph passport size 1. Name of applicant : (in block letters) 2. Sex (male/ female) : 3. Father's/ Husband's Name & Address : (including Ward No. & House No.) Occupation : Address : 4. Address (Self) : a) Permanent : b) Vill/ Locality (Name of the Revenue Village to be given): c) P.O & P.S : d) Development Block : e) Present (Detail address for Correspondence): f) Whether residing continuously for the last three year in the area from where loan is applied : Yes/ No g) With whom you are staying in the above address and since when?: 5. Age particulars a) Date of birth : b) Age as on date of application : 6. Qualification a) Academic : b) Technical : 7. Training received, if any (Give name of institute & duration): 8. Whether the Applicant is unemployed? If so, Whether registered with employment exchange? (Give upto date Renewal Regn. No. & Date) : 9. Whether the applicant belongs to S/C, S/T, OBC : 10. Whether the applicant belongs to minority Community/ Ex-Servicemen/ Physically handicap : 11. Type of Industry/ Service/Business activity Proposed to be started (Give project details) : 12. Previous experience in the line, if any : 13. Place of works where the activity as mentioned : In col.11 above is proposed to be started (Give full details) 14. Present Annual Income of the family from : All source (including salary, wages, business, Rent, pension, agricultural and other income Supported by affidavit & other documents). b) For unmarried person : Income from all sources of the parents & Self. 15. Amount of loan required (Schematic Value) : a) Machinery & equipments : b) Other fixed assets : c) Working capital : Total: Rs. 16. Margin money proposed to be invested : 17. (a) Whether taken loan from any Banking/ Financial Institution of State/ Central Govt. By the applicant or family members : b) If yes for 17(a) Give details with repayment Made till date : c) If no for 17(b) indicate the balance amount: 18. Name two commercial Bank Branches nearest to your proposed location of the venture : I here by declare that the above information are true and myself or any of my family members are not defaulter, any bank loan and has not yet received any loan under this scheme or any other Govt. sponsored subsidy link scheme from any Govt. financial institution/ bank/Co-operative societies etc. In case, if my declaration found false wrong in later date, my application will automatically be stand cancelled and I shall be liable for punishment as per law deem fit and proper. Place: Date: Signature of Applicant Declaration by parents/ guardian My son/ daughter/wife/Sri/Srimati.................has applied under PMRY Scheme is known to me. I have full consent and liability if he/ she get selected for the loan. Date: Signature of parents/ Guardian APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTER'S ROJGAR YAJANA FOR EDUCATED UNEMPLOYED YOUTH Photo affix photograph passport size 15. Name of applicant : (in block letters) 16. Sex (male/ female) : 17. Father's/ Husband's Name & Address : (including Ward No. & House No.) Occupation : Address : 18. Address (Self) : a) Permanent : b) Vill/ Locality (Name of the Revenue Village to be given): c) P.O & P.S : d) Development Block : e) Present (Detail address for Correspondence): f) Whether residing continuously for the last three year in the area from where loan is applied : Yes/ No g) With whom you are staying in the above address and since when?: 19. Age particulars a) Date of birth : b) Age as on date of application : 20. Qualification a) Academic : b) Technical : 21. Training received, if any (Give name of institute & duration): 22. Whether the Applicant is unemployed? If so, Whether registered with employment exchange? (Give upto date Renewal Regn. No. & Date) : 23. Whether the applicant belongs to S/C, S/T, OBC : 24. Whether the applicant belongs to minority Community/ Ex-Servicemen/ Physically handicap : 25. Type of Industry/ Service/Business activity Proposed to be started (Give project details) : 26. Previous experience in the line, if any : 27. Place of works where the activity as mentioned : In col.11 above is proposed to be started (Give full details) 28. Present Annual Income of the family from : All source (including salary, wages, business, Rent, pension, agricultural and other income Supported by affidavit & other documents). d) For unmarried person : Income from all sources of the parents & Self. 18. Amount of loan required (Schematic Value) : a) Machinery & equipments : b) Other fixed assets : c) Working capital : Total: Rs. 19. Margin money proposed to be invested : 20. (a) Whether taken loan from any Banking/ Financial Institution of State/ Central Govt. By the applicant or family members : d) If yes for 17(a) Give details with repayment Made till date : e) If no for 17(b) indicate the balance amount: 18. Name two commercial Bank Branches nearest to your proposed location of the venture : I here by declare that the above information are true and myself or any of my family members are not defaulter, any bank loan and has not yet received any loan under this scheme or any other Govt. sponsored subsidy link scheme from any Govt. financial institution/ bank/Co-operative societies etc. In case, if my declaration found false wrong in later date, my application will automatically be stand cancelled and I shall be liable for punishment as per law deem fit and proper. Place: Date: Signature of Applicant Declaration by parents/ guardian My son/ daughter/wife/Sri/Srimati.................has applied under PMRY Scheme is known to me. I have full consent and liability if he/ she get selected for the loan. Date: Signature of parents/ Guardian SPECIMENT OF AFFIDAVIT TO BE SUBMIT ALONGWITH THE APPLICATION ON NON-JUDICIAL STAMP PAPER DULY ATTESTED BY NOTARY. (AFFIDAVIT) I, ...............S/O. D/O. W/O................ R/O .................. do hereby solemnly affirm and declare as under. 1) That I am unemployed. 2) That I am not in a position to master my own capital for the project. 3) That I am a permanent resident of ......since .....years .... 4) That the family income of my family which includes spouse and parents is Rs..... per annum from all sources such as salary, wages, agricultural income, business, rent, interest, etc. 5) That I have not defaulted in repayment of loan from any nationalized Bank/ Financial Institution/ Co-op. Bank. 6) That I shall abide by the rules framed under the scheme of PMRY for educated unemployed youth. 7) That, I shall submit the progress report required by the Bank/ Govt. DEPONRNT Verification: Verified that the above commitments are true and to the best of my knowledge and behalf and nothing has been concealed herein. Date: DEPONRNT Note: Application should be submitted complete in all respects in duplicate along with attested copies of the following documents. 1) Age Certificate 2) Certificate of qualification-academic and technical 3) Ration Card or any other proof of residency for 3 years. 4) Experience certificate, if any. 5) Affidavit duly countersigned by the NOTARY. 6) Income certificate where applicable. 7) Cast certificate where applicable. 8) Scheme/ Project report of the proposed venture. 9) Unemployed certificate. Two copies each
