APPLICANT ID: (OFFICE USE) APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTER'S EMPLOYMENT GENERATION PROGRAMME (PMEGP) Preference for sponsoring agency of the project to Bank: (mark KVIC KVIB DIC Rural Urban TO ............. ............ Details in blocks should be entered in CAPITAL LETTERS only 1. Name of the applicant/ Institution Name PHOTO 2. Date of Birth D D M M Y Y Y Y 4.Father's name /Spouse's Name/ Contact Person Name (if Institution): 5. Communication Address: 6. Address of proposed location of unit : Rural Urban 7. Name of the preferred Bank Name & Address in the area for Project sanction Taluk/Block: District: Email: Contact No Taluk/Block: District: Bank Name: Address: Taluk/Block District: Branch Code: 8. Qualification 9. Whether Entrepreneur Development Programme Yes No (EDP at least 2 weeks) undergone: (mark ) Name & Address of Training Institute Period of training Certificate Issue Date From To 10. Whether the applicant belongs to (mark SC ST OBC PHC ExServiceman Minority Hill Boarder Area General 11.Whether the project for Manufacturing Business/Service (mark ) unit unit 12. Name of the project / business activity proposed: 13. Amount of loan required (in Rs.) 14. Details of earlier or current Loan/grant and subsidy availed from Building Capital Expenditure Loan Working capital/cash credit Limit Total Type (own/ leased/ Rented) Work shed, Building etc Machinery & equipment . Pre operative Cost I certify that all information furnished by me is true; and that I and any of my dependent have not borrowed any money under Subsidy Linked Scheme from any central/State Government or bank for establishing any such project. Date : Signature of the applicant NOTE: Own contribution must be invested 5% for SC/ST/OBC/PHC/woman/ Exserviceman/ North East Reason/Hill Boarder Area and 10% for General Total Project Cost should not exceed 25 lakhs for Manufacturing unit and 10 lakhs for Business/service unit. Applicant will not be entitled for additional Margin Money(Subsidy) in case of Own Contribution over and above the prescribed limit. VIIIth pass for Manufacturing Unit above Rs.10 lakhs project cost and under Service Sector above Rs.5 lakhs Application should be submitted complete in all respect along with attested copies of the following documents: 1. Certificate of qualificationacademic and technical (if project cost above 5 lakhs under business/service industry or above 10 lakhs under Manufacturing industry) 2. Relevant Certificate for SC/ST/OBC/Minority/ExServicemen/PHC 3. if Entrepreneur Development programme(EDP) training undergone (at least for two weeks) then submit photocopy of the certificate For Official Use only (Rejected/ to be placed before District Task force committee) Reasons (if rejected): Place: Signature, Name and Designation of Officer Date: KVIC/ KVIB/DIC
