GOVERNMENT OF GOA DIRECTORATE OF ANIMAL HUSBANDRY & VETERINARY SERVICES PASHUSAMVARDHAN BHAVAN, PATTO, PANAJI - GOA Application Form for Revised Green Fodder Cultivation (Perennial and Seasonal) 1) Name & full address of the applicant (Block letters) 2) Whether employed/unemployed profession and occupation if any 3) Educational Qualification 4) Whether having milch animals if yes Number & breed 5) Size of land holdings as per Form I & XIV records ------------------------------------------------------------------ 6) Proposed land area for perennial & seasonal separately ------------------------------------------------------------------ 7) Proposed type of green fodder cultivation (i.e. Perennial or seasonal or both) with land area in each case ------------------------------------------------------------------ 8) Whether irrigation/water supply facilities (water pump) are available and whether expenditure for the unit cost will be incurred towards manure, land preparation, cultivation, transport, harvesting, irrigation etc ------------------------------------------------------------------ 9) Form I & XIV to be attached to the application form and NOC from landowner, death certificate of landowner and power of attorney to be attached ------------------------------------------------------------------ 10) Whether own finance or from the Bank (Name & address of Bank) Amount of loan ------------------------------------------------------------------ 11) Anticipated fodder yield per hectare area ------------------------------------------------------------------ 12) Proposed varieties of green fodder cultivation mentioning the land areas of cultivation in each case. ------------------------------------------------------------------------------------------------------------------------------------------- 13) Whether wiling to execute a bond as per scheme pattern. ------------------------------------------------------------------------------------------------------------------------------------------- 14) Whether willing to sell the fodder produced to the dairy farmers, members and Dairy Co-op Societies at the controlled selling rates -------------------------------------------------------------------------------------------------------------------------------------------- 15) Whether willing to complete the project within the period of 6 years from the date of initial approval. --------------------------------------------------------------------------------------------------------------------------------------------- 16) Whether the fodder cultivation will be continued for a minimum period of 10 years from the date of initial approval ---------------------------------------------------------------------------------------------------------------------------------------------- I hereby declare that the above information given by me is true to the best of my knowledge and belief. I also assure that I shall utilize fully the subsidy and loan sanctioned to me, for increasing the green fodder cultivation in the State which will enable for self use or sell the produce to the dairy farmers/members of the Co-operative Societies under the approved/controlled rates. Sign of applicant with date CERTIFICATE Certified that I have personally visited the site of proposed plot of land for green fodder cultivation and found that the information given above is correct and that the beneficiary is having the irrigation/water supply facilities for the proposed land area under cultivation and hence the proposal is recommended for subsidy benefit under perennial/seasonal green fodder cultivation. All the records of green fodder cultivation such as follow up of inspections of fodder plots, quantity of fodder produced, the exact area of cultivated land, period of fodder cultivation etc will be maintained in this office register. Signature of the Concerned VO/Asst.Dir. with his Remarks & date Place:- Date:- Countersignature of Area Assistant Director Veterinary Hospital___________________
