1. Name of the Farmer/ Farmers OrganisationVillage : Post : P. S. : Gram Panchayat : Block : Sub-Division : District :2. Qualification 3. Total Land Holding (ha.) : Irrigated : Rainfed :Plot no. Government of Orissa Agriculture DepartmentAPPLICATION FORM FOR EXECUTION OF PRIVATE LIFT IRRIGATION POINT UNDER NEW AGRICULTURE POLICY4. Source of water he proposes to tap Ground water Flow waterStill water where he proposes to install the project (with the details) Published on National Portal of India (india.gov.in) 5. a. Own area he proposes to irrigate through the project. (Area map showing the ayacut to be enclosed) Name of the owner (Self) Plot No. Khata No. Area b. Area he proposes to irrigate by sale of water Name of the owner Total : 6. Agency through which he proposes to execute the scheme : 7. How much amount he can invest in the project from his own : 8. Is he interested to avail bank loan, if so from which bank ? 9. Sources of energy ? (Electrical/ diesel) : 10. Has he got any other L.I. Point and if so what is the ayacut ? Date Full Signature of the Applicant PlaceAddress NoYesElectricalDeisel Published on National Portal of India (india.gov.in)sRs /- Signature/ Name of the AAO/ JAO Received an application for an irrigation project from Sri of village G.P. Block for consideration. DatePlace Address Published on National Portal of India (india.gov.in)