Financial Assistance under Swabalamban

Applicant's Type

Applicant Type *

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Applicant’s Details

Name of Partnership Firm / SHG / Cooperative *

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Authorised Person's Salutation *

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Name of Authorised Person *

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Applicants Salutation *

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Name of Applicant *

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Guardians Salutation *

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Father’s / Husband’s Name *

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Relationship *

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Applicant's Date of Birth * Age limit should be in 18 - 50

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Applicant's Gender *

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Category *

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PAN *

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Whether Differently Abled *

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Applicant's Photo *

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Aadhaar Number *

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Educational Qualification

Financial Year

Applicant’s Address

District *

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Sub-Division *

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Location Type *

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Block *

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Gram Panchayat *

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Habitation *

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Municipal Corporation *

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Ward *

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Area Name/ House No. *

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Municipal Council *

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Ward *

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Area Name/ House No. *

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Nagar Panchayat *

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Ward *

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Area Name/ House No. *

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ADC Block *

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Village Council *

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Habitation *

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Police Station

Quick Search Post Office

Post Office & Pincode *

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Applicant's Contact Details

Mobile Number *

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E-Mail *

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Service Specific Information

Employment Status *

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Type of Activity Proposed *

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Description of Activity *

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Previous Experience in the Line, If Any

Proposed Place of Activity

Activity District *

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Sub-Division *

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Location Type *

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Block *

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Gram Panchayat *

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Habitation *

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Municipal Corporation *

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Ward *

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Area Name/ House No. *

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Municipal Council *

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Ward *

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Area Name/ House No. *

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Nagar Panchayat *

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Ward *

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Area Name/ House No. *

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ADC Block *

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Village Council *

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Habitation *

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Police Station

Quick Search Post Office

Post Office & Pincode *

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Project Cost

Fixed Assets (Rs.) *

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Working Capital (Rs.) *

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Total Project Cost (Rs.)

Details of Earlier Bank Loan, If Any

Whether Taken Loan from Any Bank / Financial Institution by Self / Spouse? *

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Whether all Repayments Made? *

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Supporting Documents

1. Aadhaar Card ! *

2. PAN Card ! *

3. Age Proof Certificate ! *

4. Project Report (Not More Than 8 Pages) ! *

5. Whether you want to upload any Resolution / Partnership Deed / Authorisation Letter (only if Applicant Type is Partnership Firm/ SHG/ Cooperative) ? *

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Yes

No

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6. Do you want to upload any other document ? * Filled-up form needs to be downloaded, signed, scanned and uploaded here

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Yes

No

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N.B: Please upload filled and signed (scan) copy of "Common Application Form" in Attach Annexure Page !

Declaration

I certify that all information furnished by me is true to the best of my knowledge and belief. *

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Yes

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