Application for registration of Poultry Farm / Unit with the Department of Animal Husbandry & Veterinary Services Panaji- Goa. For the purpose of claiming of Subsidy for Transportation of feed. 1) Name of Poultry Farmer:----------------------------------------------- 2) Name of Father/ Husband (if married):------------------------------- 3) Full postal Address:---------------------------------------------------- House No.Ward VillageTown Taluka 4) Tel. No. ------------- 1) Residence ---------------- 2) Mobile if any. 5) Year of establishment of farm:- 6) Name of farm:---------------------------------------------------------- 7) Address of farmer:----------------------------------------------------- Name of place Ward VillageTown 8) Type of Poultry Farm 1) Broilers------------ 2) Layers----------- 9) Capacity of farm: ------------------------------. 10) Present stock of birds 11) Whether subsidy availed from Department to start the farm Yes/No If yes detail of subsidy Amount in total 12) Quantity of feed Required at present and type of feed: 13) Quantity of feed purchased per month: ---------------------------- 14) Source of purchase of feed with name and address of the seller: 15) Whether a feed register is opened and maintained by the farmer at present, if not agree to maintain same immediately. 16) Any Additional Information:- Place: Name & Signature of farmer with date Date: 17) I hereby certify that the information given by the applicant is Verified by me and is correct to best of my knowledge. Signature of V.O./ Asstt. Director With date & Office stamp. -----------------------------------x------------------------------------
