Application Form For Grant-in-Aid under Backward Linkages Scheme 1. (a) Name & complete address, telephone No., Fax No. of Regd. Office of the company & name, address of Owner/Promoter. (b) Location of processing unit with complete address, telephone no. and fax no. (c) Licence No./Registration No. and date under FPO/MMPO/MFPO etc. as applicable 2. Period/years for which Grant-in-Aid is required. 3. If Company received grant from this Ministry in the past, give year-wise details along with purpose (enclose copies of sanctions issued by MFPI) 4. Nature of product and period of the contract. 5. Date of advance intimation about contract farming (copy of communication to be enclosed). 6. List of contracted farmers (minimum 25) and area of land, quantity purchased & amount paid to each farmer. 7. Copies of contract agreement to be entered into with each farmer in the enclosed model contract format. 8. Quantum and value of purchases made from contracted farmers during the period of claim (duly certified by CA & verified by SNA) 9. Quantum & value of extension services quality seeds, pesticides, fertilisers etc. provided to the farmers in the relevant years duly certified by CA & verified by SNA. 67 68 10. Copy of audited Statement of Accounts of the Company for the last three years to be enclosed. 11. Certificate from SNA that they have physically verified the contract agreements and found in order to be enclosed. 12. Copy of FPO/MMPO/MFPO return filed for the relevant period, with quantity and value to be enclosed. 13. Details of processing facilities/machines alongwith flow chart of the process duly authenticated by CA/CE to be enclosed. 14. Capacity of the unit and Quantity and Value of items processed and sold in preceeding three years and exports, if any duly authenticated by CA to be enclosed. 15. Percentage of value addition. Place : Name, Signature and designation of authorised signatory of the company Date : with telephone No. & Fax No. Seal of the Company Note : The above information/documents should be verified by the State Horticulture Department/ State Nodal Agency before submit-ting the same to the Government of India, Ministry of Food Process-ing Industries, New Delhi.
