VI MODEL APPLICATION FORM

APPLICATION FORM FOR FINANCIAL ASSISTANCE
UNDER PRIME MINISTERíS ROZGAR YOJANA FOR
EDUCATED UNEMPLOYED YOUTH

 

To:
The General Manager
District Industries Centre



AFFIX

PHOTOGRAPH



1. Name of the applicant :
    (in block letters)


2. Sex (male/female) :


3. Fatherís/Husbandís name :

          Occupation
          Address


4. Address (self) :
    (a) Permanent
    (b) Correspondence
    (c) Whether residing continuously
    for the last three years in the area
    from where loan is applied                          Yes/No


5. Age Particulars :
    (a) Date of Birth
    (b) Age as on date of application


6. Qualification :
    (a) Academic
    (b) Technical


7. Training received, if any :
    (Give name of the Institute & Duration)


8. Whether the applicant is unemployed? :
    If so, whether registered with
    Employment Exchange?(give
    Registration No. & date)


9. Whether the applicant belongs to :
    SC/ST/OBC


10. Whether the applicant belongs to :
     minority community


11. Type of Industry / service/business :
     activity proposed to be started
     (Give project details)


12. Previous experience in the line, if any:


13. Place of work where the activity as
     mentioned in col. 11 above is
     proposed to be started give full details:


14. Present annual income of the family :
     Duly supported by concerned MRO
     Certificate


15. Amount of loan required
     (a) Machinery & equipment
     (b) Other fixed assets
     (c) Working capital
     (d) Total


16. Margin money proposed to
     be invested by the applicant


17.(a) Whether taken loan from any
     banking/financial/institution or
     state /central govt.
     (b) If yes for 17(a) whether all&
     repayments made
     (c) If No for 17(a) indicate the
     balance amount.


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






Signature of the applicant



 Note :

ELIGIBILITY CRITERIA:

  1. 8TH CLASS PASS
  2. Age group between 18-40 years as on date of filing of application.(Relaxation upto
     10 years in case of women, SC ST, PH and ex-servicemen)
  3. Must be the resident of the address indicated in the application for the last 3 years.
  4. Family income should be below Rs.40,000 pa.

  

CHECK LIST:

Application should be submitted complete in all respects in duplicate along with attested
  copies of the following documents :


  1. Proof of Date of Birth (SSC certificate or TC from school where studied)
  2. Certificate of qualification academic and technical
  3. Ration card or any other proof of residency for 3 years, ie residential certificate issued by MRO
  4. Experience certificate, if applicable.
  5. Income certificate issued by MRO of concerned mandal
  6. Caste certificate issued by MRO if applicable
  7. Driving License in case of the candidates applying for motor vehicles.
  8. A copy of the Proposed Project Profile.

 

 

 

.oOo.