APPLICATION FORM FOR AVAILING FINANCIAL ASSISTANCE From the Cooperative Department Government of Manipur No. Financial year........................... 1. a) Name of society :b) Address of society with the : name of district c) Type of society :d) No. & year of registration : of the society e) Area of the operation of the society :f) Board of Directors / Management : elected / nominated g) Date of last General Body Meeting :held 2. Membership and paid up share capital as :on ............. No. of members paid up share capital a) Cooperatives b) State Government c) Individuals d) Others (please specify) e) SC/ST members if any : 3. Reserve / other fund (please specify) 4. Borrowing as on .......... from a) Other financial institution : b) State Government : 5. Balance if any with bank as on ............... 6. Accumulated net profit or loss as on ............. 7. Details of financial assistance so far received : State Govt. - N.C.D.C. others a) M/S and grant : ................ b) Share capital : .................. c) Loan : ................... P.T.O -2 8. Business activities :a) Type of business undertaking b) Amount involved in the business : c) Sales turnover of the business during the last 3 year 9. If the assistance is for managing subsidy a) Is the society having a paid manager b) If yes, salary paid to manager c) Amount of salary that society can pay from its resources : d) Assistance now required : 10. Present working condition of the society [ Enclose a brief note ] 11. Amount for which the application is applied for : 12. Working report of the society is to be given by the Secretary / Managing Director of the society. It should be countersigned by the concerned D.C.O. [ To be enclosed ] 13. Whether utilization certificate for the last year financial assistance as enclosed or not, If yes, it should be countersigned by D.C.O. concerned. YES / NO 14. Please enclosed the proceedings of the Board of Directors for availing the financial assistance from the state. 15. Please enclosed the audited balance sheet of the previous Year. 16. Please enclosed the photostat copy of the receipt voucher for payment of latest Annual subscription fee to the Manipur State Cooperative Union. Recommendation by the Signature of the Secretary concerned D.C.O. with Managing Director of the Society Seal. with seal
