BENEFICIARY APPLICATION FORM FOR FISHERIES EQUIPMENTS

Date of Application : ________________________________

Name of the DFO Circle : ________________________________

Name of Applicant : ________________________________

S/o/W/o/D/o : ________________________________

Block : ________________________________

GP : ________________________________

Village : ________________________________

Gender : I. Male II. Female (put a tick mark)

ID No (Voter ID card) :________________________________

Category : I. General II.SC III.ST (put a tick mark)

Mobile No : ________________________________

A/C No : ________________________________

Name of the Bank : ________________________________

Branch Name : ________________________________

IFSC Code : ________________________________

Name of Scheme : ________________________________

Name of Implement : ________________________________

Make : ________________________________

Model : ________________________________

Frame Size (Net Only) : ________________________________

Weight of Net : ________________________________

Full Cost : ________________________________

Source of Fund : I. Self II. Bank (put a tick mark)

Date: ……/……/………… Signature of the Beneficiary