AQvance Booking Form @

IrlGr nursery
1. Name of farmer

3. Contact no: ... .,. ..,Whatsapp. No.

4. Address:Village ... ....... Post ,...,.....TQ

District .State ... ... ..Pin

S No. Fruit Variety No of Plant Price / Plant TotalAmount (Rs.)

1

4
5
6
7

I
TotalAmount
*
Availability of planting materiil may take 6 months or more.*

5. Booking amount: Rs "..... ........Balance amount: Rs ......

6. Payment details : (N0 CASH DEPOSITION)

a)Cheque/ RTGS-NEFT UTR No .. . ....b) Date....

Amount:
c) ... d) Name of the bank:...
.. ... ... e) IFSC Code. ,..

f) Fr/c Holder's Name:... ...9) Bank Fr/c No:...

7. Pan Card No. ......... Aadhar Card No. ,.. ..{.......

I hereby declare that the above amount is paid from my own bank account only.
I am submitting the image of my Aadhar card and Pan card along with the Advance Booking Form.

l... .. " ... ... . agree with the advance booking scheme and will
abide by the termsand conditions mentioned in the booking procedure www.vnrnursery.in/bookinq-procedure. I have
understood the crop and risks involved in cultivation of fruit crops. VNPL will not be liable for any damage & losses
incurred during pre and post plantation & cultivation of the fruit crops.

Date: ... ..... Name:

Place: ... ....... Signature:

For official use onlv:

Delivery month to be confirmed by logistics: -Name:

VNR NURSERY P\TT. LTD.

REGI. & ADItltN. OFFICE : Corporate Ceneie, Canal Road Crossing, Ring Road No. 1, Raipur492006 (C.c.) INDIA
TEL. : 0771 4350ffi2 c FAX : OT71 435001 ,073899023301 + custoner.serv*@vnmursery,in
V\bbsite: wurw.vnmursery.in o CIN : U01400CT2012PTCm0139