GOVERNMENT OF INDIA, MINISTRY OF AGRICULTURE KRISHI BHAVAN, NEW DELHI ( APPLICATION FORM FOR AVAILING OF FINANCIAL ASSISTANCE ) 1. (a) Name and complete address of the society (b) Type / level of society (c) No. and date of Registration (d) Area of operation (e) Board of Directors Management 2. Membership and paid up Share capital as on (a) Cooperative societies (b) State Government (c) Individuals (d) Others (please specify) SC/SD Members Total 3. Financial position of the society ( as per last Balance sheet ) (a) RESOURCES : i) Paid up share capital members ii) Government share capital iii) Government subsidy iv) Reserves v) Loans/Borrowings vi) Current liabilities vii) Others ( specify ) (i) State level Apex (ii) Regional/Central/Distt. (iii) Primary Elected/Nominated No. of Members Paid up share Capital ( Rs. ) ________ ________ ___________________ ___________________ Rs. ::::::: ________________________________________ Total (b) APPLICATION : Rs. i) Fixed assets : ii) Investments in shares : Saving Certificate, Bonds, Deventures etc. iii) Transport vehicles : iv) Others ( specify ) : ________________________________________ Total (2) 4. Accumulated profit/ loss : Res. Newly registered society 5. Borrowing Source Purpose Amount Balance Arrears/ Amount of outstan-overdues Instalborrow-ding ment wing per year a) State Govt. b) Commercial Bank c) Cooperative Bank d) Others (specify) Total : 6. Business Activities : Type of Business Business Business Business expected undertaken. during the expected in the next year previous during Coop. year the current year 7. Assistance required for : Share capital/ working capital Loan 1/4 Managerial Assistance. a) If assistance required is for share capital : i) Purposed for which the borrowing : ii) Number of borrowers/members already assisted : iii) Quantum of assistance provided : per borrowers iv) Number of borrowers : proposed to be assisted : v) Average quantum of assistance : vi) Total Amount required : vii) Amount proposed to be raised by way of additional share capital during the year : viii) Share Capital assistance now required from State Govt./ GOI b) If the assistance required is for working capital : i) Value of goods marketed : ii) Business projected during the next three years : iii) Amount of business turnover : during the year. iv) Amount of working capital : required for production, marketing v) Owned funds available to meet : working capital vi) Balance of working capital required : (3) vii) Amount of margin money required to : raise this additional working capital c) If the assistance is for Managerial purpose assistance : yes/no i) Is the society having a paid Manager or not ii) If yes ( year salary paid ) : Rs. _____________ p.m. iii) If no, does the society intends to appoint a paid : Yes/No Manager iv) Propose salary of Manager : Rs. _____________ p.m. v) Annual salary of Manager : Rs. _____________ p.m. vi) Amount of salary that the society can pay/ from its resources. : Rs. _____________ p.m. vii) Managerial Subsidy/ provided by the State Govt. : Rs. _____________ p.m. viii) Assistance now required : Rs. _____________ p.m. 8. a) A copy of the audited Trading & profit and : loss accounts of society for the current year b) Tentative Trading and profit and loss Balance : sheet for the current year. c) A copy of the bye laws of the society : d) Annual Report of the Society for the last : year (Latest) e) A copy of the Resolution of the Board of : Directors for availing of the proposed assistance 9. I Shri/Smt. ......................... President/ Chairman/Secretary of the ..................................... (Society's Name) on behalf of the society request that the assistance applied for in the above application may please be sanctioned. I/we further agree to abide by the terms and conditions of assistance so provided by the Government of India/State Governments of _____________________________ and furnished all such reports / information as prescribed by the State Govt. of __________________ Government of India. Signature of the President/ Secretary/Chairman or any Authorised signatory with Seal/Stamp PROJECT FOR SANCTION OF FINANCIAL ASSISTANCE UNDER THE GENERAL SECTION SCHEME "ASSISTANCE TO WOMEN'S COOPERATIVES" 1. State : 2. Name of the Society/ : Project. 3. Number of the members : To be benefited. 4. Share Capital : 5. What are the assets : likely to be created by the working capital loan. 6. Amount of additional : income to each member 7. Estimated turn over : 1st year 2nd year 3rd year for next three years with the assistance 8. Projected economy : 1st year 2nd year 3rd year i) Sales turn over : ii) Gross profit : iii) Other Income : iv) Total Expenditure : v) Net Income : vi) Net Savings : 9. How many persons : to be employed
