A P MINORITIES FINANCE CORPORATION LIMITED APPLICATION FOR FINANCIAL ASSISTANCE TO INDIVIDUALS Registration No: Date: Scheme: Economic assistance (Bankable) Scheme. / Minorities Artisan Development Scheme. Name: D/o / W/o: Sex: Male Female Date of Birth: Age: Minority Community: Muslim Christian Sikh Buddhist Parsi Residential Address : Door No. Land Mark Street Ward/Village City/Municipality/Mandal District Constituency Contact Phone No. Literate: No Yes If Yes, Qualifications Ration Card No. Pink White No re you Physically Challenged? Yes No %of Disability A Family Annual Income from all sources: Rs. Activity Proposed: Place of Proposed Activity: Activity Status: New Existing Experience (years) If Unit Already Existing: Address Unit Cost: Rs. Self Contribution: Rs. Loan Required: Rs. Nearest Bank & Branch Name: Place : Date : Signature of the Applicant Note: The beneficiary shall be contribute 10% of the Unit cost and the APSMFC will provide Subsidy @ 50% of the Unit cost, Subject to a maximum limit of Rs. 30,000/-. Recent Passport Size Photo attested by MPDO/ Municipal Commissioner / Related Bank Branch Manager Enclosures required: Self declaration of annual income along with Xerox copy of ration card OR Income certificate by Tahasildar. One passport size photo graph attested by MPDO / Related Bank Branch Manager. SELF DECLARATION OF INCOME I, (the above applicant) hereby declared that my family income per annum from all sources is Rs._______ in words (Rupees ___________________________________________). Also enclosed my Ration Card No. ______________ issued in the year _________ with annual income Rs. _______. Place : Date : Signature of Applicant OR INCOME CERTIFICATE (To be certified by Tahasildar) This is to certify that Sri/Smt/Kum._______________________________ S/o. D/o, W/o______________________________ R/o _________________________ His/Her family annual income is Rs. _________________ in words (Rupees_____________________ ______________________________) Place : Date : Signature of Tahasildar (With Seal) FOR OFFICE USE ONLY Application Considered : Yes No Date of Bank Loan Sanctioned : Total Unit Cost Considered : Bank Loan Subsidy Beneficiary Contribution Date of Documentation : Date of Subsidy Released : Pro. No. Date : Date of Data Entry: Data Entered By: File Name: Data Verified by:
