GOVERNMENT OF GOA DIRECTORATE OF ANIMAL HUSBANDRY & VETERINARY SERVICES, PATTO -PANAJI-GOA APPLICATION OF SETTING UP OF 500 BROILERS/1000 LAYERS AND MODERN POULTRY UNITS SCHEME. 1) Name of the applicant in block letters: - ------------------------------------ 2) Father's name/Husband name if married: ---------------------------------- 3) Full postal address with details of Tel. No. / H.No., Ward , Village, Town, Taluka :--------------------------------------- 4) Whether employed/unemployed/ profession and occupation if any 5) Educational Qualification:- -------------------------------------------------- 6) Date of birth and age: ------------------------------------------------------- 7) Whether with own finance OR with the Bank loan ------------------------ Name and address of the Bank: - ------------------------------------ 8) Type of Poultry unit to be set up -------------------------------------------- 500 broilers/1000 layers/ ------------------------------------------- Modern poultry units. ------------------------------------------- 9) Form I & XIV to be attached and / --------------------------------------- or N.O.C. from the landowner and/ --------------------------------------- or the land lees document ---------------------------------------- 10) Whether the member of the Goa State Poultry ---------------------------- Co-operative Society ----------------------------------------------------- 11) Whether willing to shoulder the responsibility of marketing the poultry products ---------------- 12) Whether owning any old poultry shed/unit---------------------------------- If so give specifications/details of the existing ----------------------------- Unit. -------------------------------- 13) Whether the applicant or any member of his/ her family members has taken subsidy earlier----------------------- for poultry units. If so give details/year etc. ---------------------- 14) Whether willing to Execute a bond as per scheme guidelines and whether willing to --------------------------- complete the project within six months ---------------------------- period from the date of approval. ---------------------------------- 15) Full address of the Project site with survey ----------------------- site plan and plan of the poultry shed. ------------------------------- of modern poultry unit duly signed by the applicant and countersigned by the respective Area Veterinary Officer/Asst.Director 16) Whether willing to market the poultry -------------------------------- products through Goa State Poultry -------------------------------- Farmers co-operative society/Goa State Poultry Marketing Federation, if they---------------------------------- are functional. 17) Whether willing to continue with the project for a ------------------- minimum period of 10 years ----------------------------------- 18) Whether the applicant has own land for ----------------------------- construction of the unit. Or whether he is a ------------------------ tenant or holding land on lease basis ----------------------------- I hereby declare the above information given by me is true to the best of my knowledge and belief. I also assure the Government that I shall utilize the subsidy & loan to the full extent if same sanctioned to me for creating the intended asset, to enable me to carry on my profession/trade, failing which I shall be liable to refund the subsidy and the Bank loan. Signature of the applicant with date (Shri/Smt. _______________________) 19) Remarks of the Area Veterinary Officer/ Asstt. Director, with office stamp & date I hereby certify as under:- a) The information given above by the applicant is correct. b) I have conducted the proposed site inspection on ---------------- and found that the applicant wish to establish a new poultry unit alongwith new plant and machinery equipments as per the scheme guidelines. He is not having old structure of poultry sheds. c) The project report is verified and countersigned and is feasible d) The proposal is found to be healthy & considerable and has got land and capacity to establish the poultry unit by his own Bank Finance. Signature of Veterinary Officer/Asst. Director With Date & Office Stamp
