APPLICATION FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTER'S ROZGAR YOJANA FOR EDUCATED UNEMPLOYED YOUTH 1. Name of the Applicant (in block letters) 2. Sex (Male/Female) 3. Father's Name Occupation Address 4. Address (Self a) Permanent b) Correspondence c) Whether residing continusly for the last three years in the area from where loan is applied 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 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/STBC (if yes, enclose certificate) 10. Type of industry/service/business activity proposed to be started (Give project details in the prescribed format attached with the application form) 11. Previous experience in the line, if any (Give details) 12. Place of work where the activity as mentioned in col 10 above is proposed to be started (give full details) 13. Present annual income of the family 14. Amount of loan required a) Machinery & Equipments b) Other Fixed assets c) Working Capital Total: 15. Margin money proposed to be invested 16. a) Whether taken loan from any Bank/Financial Institution of State/Central Govt. b) If 'Yes' for 16 (a) whether all repayments made c) If 'No' for 16 (a) indicate the balance amount 17. I certify that all information furnished by me is true and that I have no borrowing arrangement for my above proposed industrial/service/business concern with any bank/financial institution. Signature of the Applicant Note: Application should be submitted complete in all respect in duplicate along with attested copies of the following documents: 1. age certificate 2. Certificate of qualification - academic and technical 3. Ration card or any other proof of residency for 3 years 4. Experience certificate, if applicable. PROJECT DETAILS (To be filled in by the applicant) I. Type of Project : Industry/Service/Business II. Name of Project : III. Land a) Location b) Extent c) If own, Value : : : Own/Rented Rs. IV. Building a) Floor area b) Door No. c) If own, Value d) If rented, Monthly Rent : : : Rs. Rs. V. List of plant and machinery with approximate cost : Sl. No. Item Cost (Rs) 1. 2. 3. 4. 5. VI. Power requirement : HP VII. Employment : Nos. VIII. Important raw materials : IX. Working Capital : Rs. Signature (Specimen of Affidavit to be submitted (after selection) in Non-judicial stamp paper worth Rs. 5 duly attested by Notary Public/Executive Magistrate) AFFIDAVIT I .................. S/o / D/o / W/o.............. residing at ........... Dist/ State ................ do herby solemnly affirm and declare as under: 1) that I am unemployed 2) that I am not in position to muster my own capital for the project. 3) That I am a permanent resident of ............ since ..years 4) That the family income of my family which includes spouse and parents is Rs. .. Per annum from all source such as salary, wages, agricultural income, business, rent, interest, pension etc 5) That I have not defaulted in repayment of loan from any Nationalised Bank/Financial Institution/Co-operative Bank. 6) That I shall abide by the rules framed under the PMRY scheme for educated unemployed youth 7) That I shall submit the progress report required by the Banks/Government. DEPONENT VERIFICATION Verified that the above contents are true and correct to the best of my knowledge and belief and nothing has been concealed therein. Place: Date: DEPONENT
