APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER

SWAVALAMBAN FOR THE YEAR-

Photograph
To
(Passport
The General Manager
Size)
District Industries Centre

…………………………………………….District, Tripura

1. Name of the Applicant

(IN BLOCK LETTERS)

2. Name of Father/ Husband

3. Full Address of the Applicant

a) Permanent

b) Present

4. Contact Number

5. Aadhaar Number

6. PAN NO.

7. M.C. Word No./ NP Ward No./ G.P. Name

8. Date of Birth of applicant

9. Qualification
a) Academic
b) Technical

10. Training received (if any, give name of

institute & duration)
11. Whether the applicant in unemployed?
(If so, whether registered with employment
exchange? Give registration No. & Date
12. Whether the applicant belongs to
SC/ST/OBC, if yes, please indicate

13. Type of Industry/Service/Business activity

proposed (project details to be enclosed)
 14. Previous experience in the line, if any

15. Proposed place of activity

16. Present annual income of the applicant Rs.

17. Project Cost: Rs.

a) Machinery & Equipment Rs.

b) Other fixed assets Rs.

c) Working capital Rs.

18. Source of Finance:

a) Own Contribution Rs.

b) Bank Loan Rs.

c) Assistance from State Govt. Rs.

Total-
19. Details of Earlier Bank Loan (If any)

a) Whether taken loan from any bank/

Financial Institution of State/Central
Govt.?

b) If yes, whether all repayments made Rs.

c) If so, indicate the balance amount

I certify that all information furnished by me is true and that I have no borrowing agreements for
my above proposed industrial/ service/ business concern, with any bank/ Financial Institution.

Date: ______/_______/_______ Signature of the Applicant