GOVERNMENT OF GOA DIRECTORATE OF ANIMAL HUSBANDRY & VETERINARY SERVICES PASHU SAMVARDHAN BHAWAN PATTO-PANAJI-GOA. (APPLICATION FOR ESTABLISHMENT OF A MODERN DAIRY UNIT CONSISTING OF MINIMUM TEN MILCH ANIMALS.) 1. Name of the Applicant in Block Letters: - 2. Father's /Husband's name:- 3. Permanent Address: a) Ration Card No: ------------------------------------------------- b) House No: ------------------------------------------------- c) Ward / Locality ------------------------------------------------- d) Village / Town: ------------------------------------------------- e) Taluka ------------------------------------------------- f) District ------------------------------------------------- g) Telephone No. ------------------------------------------------- 4. Whether employed / unemployed. Profession and occupation if any 5. Date of Birth / Age 6. Educational / Qualification. 7. Whether by own finance or Bank loan Name & Address of the Bank. 8. N.O.C. from Village Panchayat/ Municipality whether enclosed 9. Whether the applicant or any member of his / her family has taken subsidy earlier for such a unit and under 1 to 10 Milch Animal Scheme. If so give details. 10. Whether owning any cattle shed if so give specification/details. 11. Whether for establishment of New Dairy Project or for Expansion of existing dairy unit, for purchase of Equipments for existing dairy unit and renovation of existing cattle shed, give details. 12. Form I & XIV to be attached and N.O.C.from the landowner if applicant's name does not figure on I & XIV Form. 13. Whether willing to executive a bond as per Scheme pattern and milch animals(Minimum 10) from neighbouring State Markets. 14. Whether to complete the Project within six months period from the date of approval letter. 15. Survey Site Plan/Plan of the Cattle Shed to be attached and Address of the site project. 16. Project report giving the details such as your requirement/prospects and Economics of the project is to be attached. 17. Whether supply of Milk will be done to the Dairy Co-operative Society and whether willing to insure his milch Animals immediately after purchase. 18. Whether a member of the Dairy Co-operative Society. If so, name & address of the Society. If not whether willing to become member. 19. Whether the project will be continued for a minimum period of 10 years in working condition. 20. Number and breed of Milch animals to be purchased and from where. 21. Whether applicant already owning C.B.Cows, local cows she buffaloes, & other Dairy Animals. If so, mention their Numbers and year of purchase. State if any existing machinery with the applicant. I, hereby declare that the above information given by me is true to the best of my knowledge and belief. I also assure you that I shall utilized fully the subsidy and loan sanctioned to me, for creating the intended asset, to enable me to carry on my profession /trade, failing which I shall be liable to refund the subsidy and the loan. Certificate and remarks to be given by the Area Veterinary Officer/Assistant Director with stamp and date by incorporating. a) The information given above by the farmer is correct. b) The records of Ear Tagging/ Identification of the existing Animals is done and are maintained in the Office. c) Conducted the site inspection of the proposed area and following observations are noticed (if any) d) After inspection, the proposal found to be healthy, feasible and farmer has not ample land and capacity to establish the Dairy Unit by this own finance/financing Institute. e) The project report submitted by the farmer is verified and countersigned. Signature of the Veterinary Officer Assistant Director with date and Office stamp.
