मुख्यमंत्री स्वरोजगार योजनांतगगत आवेदक द्वारा शपथ पत्र / घोषणा

मैं …………………………..…………..………………. पुत्र/पुत्री/पत्नि श्री/श्रीमती ……………………..……………………....

त्निवासी गाांव ………………….……………….……… पोस्ट……..……….……… ब्लॉक/तहसील………………….…………
त्निला………………………….....……..…… राज्य………………..……..……… यह घोषणा करता/ करती हूँ त्नक:

1. esjs }kjk foxr ikap o”kksZ esa fdlh Hkh jkT;@dsUnz ljdkj }kjk lapkfyr vuqnku ;kstuk
ds vUrxZr _.k ugha fy;k x;k gS] o eSa fdlh Hkh cSad }kjk pwddrkZ ¼defaulter½
ugha gWwaA
2. eSa tkurk gwWa fd izkstsDV dh O;ogk;Zrk ij vk/kfjr izkstDs V dks eatwjh nsus dk fu.kZ; dk
vfUre vf/kdkj ftyk VkLd QkslZ lfefr dks gksxkA
3. eSa tkurk gwaW fd ;kstuk ds vUrxZr izkstsDV yxkus ds fy;s ifjokj ds ,d O;fDr dks gh
foRrh; lgk;rk izkIr djus ds fy;s vf/kd`r gksxkA ifjokj esa Lo;a vkSj ifr ;k iRuh
‘kkfey gSaA
4. eSa tkurk gWwa fd ,d ckj _.kh ds i{k esa ekftZu euh tkjh gks tkrh gS rks bl ykHkkFkhZ
ds uke ls foRriksf”kr cSad ‘kk[kk Lrj ij nks o”kksZ ds lko/kh tek jlhn ¼TDR½ ds :i
esas j[kk tk;sxk o VhMhvkj ij dksbZ C;kt ns; ugha gksxk] o VhMhvkj ds lerqY; _.k
ij dksbZ C;kt pktZ ugha fd;k tk;sxkA
5. eSa bdkbZ dk ,dy Lokeh gWaw esjs }kjk _.k&lfClMh dk lnqi;ksx fd;k tk;sxk] o
_.k ftl dk;Z ds fy;s Lohd`r fd;k x;k gS] mlh dk;Z es mi;ksx d:axkA
6. eSa bdkbZ dk HkkSfrd lR;kiu ftyk m|ksx dsUnz@cSad ds vf/kdkfj;ksa }kjk le;≤
ij djus ds fy;s lgefr nsrk gwWaA
7. ;g ,rn~}kjk ?kksf”kr fd;k tkrk gS fd esajs }kjk vkosnu i= esa nh x;h lHkh tkudkjh
lgh gS vkSj ;fn dksbZ tkudkjh xyr ;k Hkzked gksuk ik;k tkrk gS rks ftyk m|ksx
dsUnz dkuwuh dk;Zokgh djus gsrq Lor=a gksxkA

त्नििाांक …………… लाभार्थी के हस्ताक्षर

स्र्थाि ……………… (िाम एवां पता)

Affidavit/ Declaration by the applicant under the Chief Minister's
Self-Employment Scheme

I ……………………………… Son/ Daughter/ Wife of Mr./ Mrs..………………….

………………… Resident Village …………………………………… Post………….
…………………. /Tehsil ………….……………... State …………………….………
declares that:

1. I have not taken a loan under any State/ Central Government grant
scheme in the last 5 years and I am not a defaulter by any bank.
2. I know that the District Task Force Committee will have the final right to
decide the project based on the feasibility of the project.
3. I know that only one person of the family shall be authorized to get
financial assistance for the project under the scheme. The family consists
of self and spouse.
4. I know that once the margin money is released in favor of the borrower,
the bank will be kept as a 2-year term deposit receipt (TDR) at the bank
level funded in the name of this beneficiary and any interest payable on
the TDR No interest will be charged on the loan equivalent to TDR.
5. I am the sole owner of the unit, I will use the loan-subsidy properly, and I
will use it for the work for which the loan has been approved.
6. I agree to carry out physical verification of the unit from time to time by
officers of District Industries Center / Bank.
7. It is hereby declared that all facts furnished above by me/us in the Govt.
Subsidy claim are correct and if any information is found to be false or
leads to misguiding the authorities with ulterior motive of availing Govt.
Subsidy. I/We should be subjected to any punishment as deemed fit in the
eyes of law.

Date …………………. Signature of the beneficiary

Location ……………. (Name and Address)