(APPENDIX 1) Bank A/c No:

84381521662765
IFSC CODE :
XXXXXXXXXXX
Cane Area related Declaration Form Bank/ Branch Name:
PRATHMA JALALPUR
Cane Supply Mode:
TROLLEY-63

I MOHD FAIZAN S/W/O MOHD RIZWAN Village GAJIPURA Hamle(Majra) Gajoopur

Tehsil: Bilari District: Moradabad Solemnly and truthfully declare that I have
cultivated cane for the season 2023 as per following
details:

-----------------------------------------------------------------------------------
---------------------------------------------------------
<----------------------Gata wise Culturable Area and Cane Area
(Hectare)----------------------> Variety
-----------------------------------------------------------------------------------
---------------------------------------------------------
SNo. Plot Village Khasra No Khatauni Total Cult. Farmer's
Share Cult. Area of Gata wise Plant Ratoon Autumn
Gata No Area
Percentage Farmer Cane Area
-----------------------------------------------------------------------------------
---------------------------------------------------------
1 6055 BANCHALBHUD 407 000012 0.299 33
0.099 0.100 ----- Co.-0238 -----
2 6189 GAJIPURA 386 0012 0.040 33
0.013 0.013 Co.-0238 ----- -----
-----------------------------------------------------------------------------------
---------------------------------------------------------
Total 0.339
0.112 0.113
-----------------------------------------------------------------------------------
---------------------------------------------------------
Note
1. I certify that I am a bonafide member of Co Operative Cane Development Union Ltd
Bilari.
I am cultivating cane since last ____ years and supplying cane to the sugar mill
through the cane society.
2. I also declare that the information provided by me is completely true and none
of the information is false or incorrect. In case of a
discrepancy in above information, the Cane Department or Co operative Cane
Development Union Ltd. has the right to take penal
action against me and the concerned cane development Union Ltd will have the right
to cancel my membership.
Date:

Signature of Decelerator with Mob.No

& Identification documents Aadhar No

1.

2.