GOVERNMENT OF GOA DEPARTMENT OF ANIMAL HUSBANDRY & VETERINARY SERVICES, PASHU SANVARDHAN BHAVAN, PATTO- PANAJI- GOA (SPECIAL CALF REARING SCHEME) APPLICATION FORM (One form is to be utilized per calf) 1) Name of the beneficiary ----------------------------------------- 2) Address----------------------------------------------------------- 3) Tel. No. or Contact Tel. No.-------------------------------------- 4) Educational Qualification:---------------------------------------- 5) Profession:-------------------------------------------------------- 6) Ration Card No:-------------------------------------------------- (Copy to be enclosed having beneficiary) 7) whether benefit of scheme was availed earlier (YES/NO) (If yes, Give details below) 8) Identification Mark -------------- Tag No. --------- Age ------- a. b. c. d. 9) Date of Birth of Calf ---------------------------------------------- (for which feed assistance is applied) 1) Identification Mark --------------------------------------------- 2) Whether farmer has facility to rear calf ------------------------ 3) Previous experience in the field -------------------------------- 4) Present weight of calf and age ---------------------------------- 5) Registration number --------------------------------------------- 6) Whether member of Dairy Co-operative Society. Yes/No 7) If yes, Name of the Dairy Society. 8) I solemnly state and affirm that I will not take feed under any other Govt. Scheme or from any other organization/ Institution for this particular calf. Signature of Applicant I consider that the case is feasible and the beneficiary has the desire to rear the animal as per recommendation of the Department. Further, I verify that the Calf is not getting feed from any other scheme of the Govt/ other Institution. Signature of E.O. I agree to all the points in the application and to the remarks of E.O. (AH) Signature of V.O. Dated:-
