Download Application Form for Grant of Loan under Micro/Direct Financing Scheme in collaboration with National Handicapped Finance & Development Corporation(NHFDC)

J&K STATE WOMEN'S DEVELOPMENT CORPORATION LTD. 615-A, Gandi Nagar, Jammu/Old Secretariat Srinagar APPLICATION FORM FOR GRANT OF LOAN UNDER MICRO/DIRECT FINANCING SCHEME in collaboration with National Handicapped Finance & Development Corporation (NHFDC) (To be filled in Duplicate) PART - A S. No. ..... 1. Name of the Applicant ___________________________________________ (in Block Letters) 2. D/o, W/o ____________________________________________________________________ 3. Address _____________________________________________________________________ 4. State ________________________________ 5. a) Date of Birth _______________________ b) Age as on ____________________________ 6. Details of disability ____________________________________________________________ (Attach a copy of certificate from competent authority) 7. Percentage of disability 8. Family details a) Males ____________ b) Females ___________ c) Children _____________ 9. Annual Income ___________________________(Not to exceed 80,000 in rural areas & 1 lac in Urban areas.) (Affidavit enclosed) (If dependent, please give income of family/spouse) 10. Educational Qualification _______________________________________________________ 11. Experience of the applicant _____________________________________________________ (any training received) 12. Whether belong to SC/ST/OBC/Other _____________________________________________ 13. Activity proposed to be undertaken _______________________________________________ 14. Location ____________________________________________________________________ 15. Cost of Project _______________________________________________________________ 16. Amount of loan required _______________________________________________________ 17. Has the applicant taken any loan from a bank/Financial Institution under any scheme, if yes please indicate. A) Amount of Loan __________________ B) Purpose __________________ C) Outstanding __________________ D) Amount repaid __________________ E) Organisation __________________________________________________________ JKWDC.CO M CERTIFICATE I/We certify that all information furnished by me/us is true that I/We have no borrowing arrangements for the unit with any bank/financial institution, except as mentioned above, that no action has been/is being taken against me/us, that I/We shall furnish all other information that may be required by you in connection with my/our application that this may also be exchanged by you with any agency you may deem fit; and I shall abide by all the terms and conditions as are or may be laid down by the J&K State Women's Development Corporation from time to time in respect of such loan. Signature of the Application PART - B Certificate To be given by the concerned Medical Officer. Certified that Miss/Mrs _________________________ D/o, W/o _______________________ R/o ________________________________________ whose photograph has been attested by me and who has signed this form in my presence is a permanent resident of _______________________ Distt _________________ belonging to __________________ class and is physically handicapped. Date: Place: Seal & Signature of the Certifying Authority. PART - C FOR OFFICE USE ONLY Name _____________________________________ W/o, D/o _______________________________ R/o ________________________________________ Distt. ____________________________ Form No. ________________________________ Trade ________________________________ Applicant is handicapped in respect of _________________________________________________ checked by ___________________________________________ Desg. ______________________________ Date _______________________________________ Sign _______________________________ JKWDC.CO M (Affidavit on Rs. 5/- Stamp Paper with Rs. 10/- Adhesive Stamp Paper duly notarized) SPECIMEN OF THE AFFIDAVIT TO BE SWORN/AFFIRMMED BY THE APPLICANT BEFORE THE COMPETENT AUTHORITY AFFIDAVIT I .................. D/W/o .................. R/o . ...................................... hereby solemnly affirms and declares as under:- 1. That I am a permanent resident of Jammu and Kashmir State residing ............ from the last ............ years 2. That I belong to ............. Muslim/Sikh/Buddhist/Christian/Zoroastrian Community. 3. That my family income per annum is Rs. ................. from all Sources. 4. That I have not drawn loan/financial assistance under any scheme of the state Govt. or Bank, Corporation of Financial Institution or Central Government and I am also not indebted to any Bank or Financial Institute. 5. Neither me nor any member of my family is in the Govt. Service and am also not indebted to any Bank of Financial Institute. 6. That I shall utilize the loan only for the purpose to which it will be given to me by J&K State Women's Development Corporation. In case of any deviation/default, I shall be liable to immediately repay to the corporation the full amount of loan granted to me with the amount of interested penalty as applicable. 7. That I am Physically Handicapped have .............. type of disability. 8. I undertake to abide by all terms and conditions as or will be laid down by J&K State Women's Development Corporation from time to time. Deponent Verified this day of ........................... that the above averments made in the affidavit are correct ant true to my knowledge and belief and nothing has been concealed thereon. Deponent Date: .......... Place: .......... JKWDC.CO M