Appendix-1 to Annexure-I

APPENDIX-1 TO ANNEXURE-I

DETAILS OF BENEFICIARIES ASSISTED

NAME OF THE CHANNELISING AGENCY :

NAME OF THE SCHEME (LOI No.) :

(Rs. In lakh)

Name & & Address / Age / Sex / Unit
Cost / NSFDC’s
Share / Disbursement of NSFDC’s Share / Beneficiaries / Category
Code / Annual
Family
Income / Remarks
Rural Urban
M / F / M / F
Cheque ./
DD No. / Date / Amount
Disbursed

ADD : Reported in previous quarters.

TOTAL :

CERTIFIED THAT ALL THE BENEFICIARIES COVERED UNDER THE LIST WERE ELIGIBLE FOR ASSISTANCE AS PER ELIGIBILITY CRITERIA.

SIGNATURE

(AUTHORISED SIGNATORY)

NAME & DESIGNATION OF OFFICIAL

Note :

(i) Details of type of vehicle may be indicated in the remarks column, in case where single sanction consists of different types of vehicles.

(ii) Separate sheet to be used for each scheme.

(iii) Please indicate Category Code as (1) for Educated Unemployed/under employed (2) for Women and (3) for Artisans & (4) for others.

ANNEXURE-II

FORMAT NO.1

NATIONAL SCHEDULED CASTES FINANCE & DEVELOPMENT CORPORATION, DELHI

FORMAT OF APPLICATION

FOR

FINANCIAL ASSISTANCE FOR NON-FARMING AND OTHER ACTIVITIES

(THIS IS ONLY A FORMAT AND NOT AN APPLICATION FORM)

1. DETAILS OF THE PROMOTER(S) :

(Name, Age, Address, Present Occupation,

Present Income Level, Details of Family

Members)

2. PROPOSED ACTIVITY :

(Details of Activity, Location and

Area of Operation, Skill Level

Required for Operating the Activity &

Experience in the line)

1.  COST OF PROJECT :

Sl.
No. / Particulars / Cost
(Rs.)
(i) / Building (to be supported by documents)
(ii) / Plant and Machinery (to be supported with quotation)
(iii) / Misc. Fixed Assets (to be supported with quotations)
(iv) / Preliminary & Pre-operative expenses
(v) / Contingencies and cost escalation
(vi) / Others, if any (registration expenses, insurance expenses etc.)
(vii) / Working Capital
(Details of requirement of working capital to be furnished)
TOTAL

4. MEANS OF FINANCE

Sl.
No. / Source / Per Unit / %age / Total for ___ Units
(Rs.)
(i) / Promoter’s Contribution
(ii) / Subsidy
(iii) / Margin Money Loan (SCA)
(iv) / Term Loan/Seed Capital/Working Capital - NSFDC
(v) / Banks
(vi) / Others, if any, specify
TOTAL

5. DETAILS OF PROFITABILITY :

(Please give details of sales revenue

and details of expenditure of operations

for a normal year of operation)

6. TECHNICAL DETAILS :

(Give technical details such as

skill requirement, raw material

requirement, power requirement

manufacturing process etc.

in 200 words)

7. MARKETING ARRANGEMENTS :

ANNEXURE-III

FORMAT NO.2

NATIONAL SCHEDULED CASTES FINANCE & DEVELOPMENT CORPORATION, DELHI

FORMAT OF APPLICATION

FOR

FINANCIAL ASSISTANCE FOR FARMING AND OTHER ALLIED ACTIVITIES

(THIS IS ONLY A FORMAT AND NOT AN APPLICATION FORM)

1. DETAILS OF THE PROMOTER(S) :

(Name, Age, Address, Present Occupation,

Present Income Level, Details of Family

Members)

2 PROPOSED ACTIVITY :

(Details of Activity, Location and

Area of Operation, Skill Level

Required for Operating the Activity &

Experience in the line)

3. COST OF PROJECT :

PART-I – LAND BASED ACTIVITIES

Sl.
No. / Particulars / Cost
(Rs.)
(i) / Land (with full details of location and value)
(ii) / Cost of Land Development
(iii) / Provision for Irrigation Facilities
(to be supported with quotation)
(iv) / Plant and Machinery (to be supported with quotation)
(v) / Misc. Fixed Assets (to be supported with quotations)
(vi) / Preliminary & Pre-operative expenses
(vii) / Contingencies and cost escalation
(viii) / Others, if any (registration expenses, insurance expenses etc.)
(ix) / Working Capital
(Details of requirement of working capital to be furnished)
TOTAL

PART-II – DAIRY

Sl.
No. / Particulars / Cost
(Rs.)
(i) / Building (to be supported by documents)
(ii) / Cost of Animals (No. & Purchase Price/Animal)
(iii) / Misc. Fixed Assets (to be supported with quotations)
(iv) / Insurance Charges
(v) / Working Capital
(Details of requirement of working capital to be furnished)
TOTAL

PART-III - TRACTOR AND AGRICULTURAL IMPLEMENTS

Sl.
No. / Particulars / Cost
(Rs.)
(i) / Cost of Tractor and Agricultural Implements
(ii) / Misc. Attachments (to be supported with quotations)
(iii) / Others, if any (Transportation cost, registration cost, insurance cost etc.)
TOTAL

4. MEANS OF FINANCE

Sl.
No. / Source / Per Unit / %age / Total for ___ Units
(Rs.)
(i) / Promoter’s Contribution
(ii) / Subsidy
(iii) / Margin Money Loan (SCA)
(iv) / Term Loan - NSFDC
(v) / Banks
(vi) / Others, if any, specify
TOTAL

5. DETAILS OF PROFITABILITY :

(Please give details of sales revenue

and details of expenditure of operations

for a normal year of operation)

6. TECHNICAL DETAILS :

(Give technical details such as

skill requirement, raw material

requirement, power requirement

etc. in 200 words)

7. MARKETING ARRANGEMENTS :

ANNEXURE-IV

FORMAT NO.3

NATIONAL SCHEDULED CASTES FINANCE & DEVELOPMENT CORPORATION, DELHI

FORMAT OF APPLICATION

FOR

FINANCIAL ASSISTANCE FOR TRANSPORT ACTIVITIES

(THIS IS ONLY A FORMAT AND NOT AN APPLICATION FORM)

1. DETAILS OF THE PROMOTER(S) :

(Name, Age, Address, Present Occupation,

Present Income Level, Details of Family

Members)

2. PROPOSED ACTIVITY :

(Details of Activity, Location and

Area of Operation, Skill Level

Required for Operating the Activity &

Experience in the line)

3 COST OF PROJECT :

Sl.
No. / Particulars / Cost
(Rs.)
(i) / Cost of Vehicle (to be supported with quotations)
(ii) / Misc. Attachments (to be supported with quotations)
(iii) / Others, if any (Transportation cost, registration cost, insurance cost etc.)
TOTAL

4. MEANS OF FINANCE

Sl.
No. / Source / Per Unit / %age / Total for ___ Units
(Rs.)
(i) / Promoter’s Contribution
(ii) / Subsidy
(iii) / Margin Money Loan (SCA)
(iv) / Term Loan - NSFDC
(v) / Banks
(vi) / Others, if any, specify
TOTAL

5. DETAILS OF PROFITABILITY :

(Please give details of sales revenue

and details of expenditure of operations

for a normal year of operation)

6. TECHNICAL DETAILS :

(Give technical details such as

skill requirement, maintenance

and repair facilities requirement

etc. in 200 words)

7. MARKETING ARRANGEMENTS :

ANNEXURE-V

AFFIDAVIT

(on Stamp Paper of appropriate value)

I______son/daughter/wife of ______residing at ______do hereby solemnly affirm and state on oath as follows:-

1.  I, submit that I belong to______(Caste Name) which comes under Scheduled Caste in the State of ______.

2.  Further, I submit that I am not an Income Tax Assessee and that my Annual Family Income is Rs.______(in words) ______from all sources. My family comprises of ______, ______, ______, ______.

3. The above declaration is given by me for the purpose of obtaining loan under the scheme of ______(SCA) and National Scheduled Castes Finance and Development Corporation (NSFDC). In case any of the facts declared by me as above are found incorrect, I fully understand that I am liable for action in accordance with the Lending Policies of SCA & NSFDC.

DEPONENT

Identified by me

SWORN TO, BEFORE ME

Place : Stamp

Date :

(NAME & ADDRESS OF NOTARY)

[Separate Affidavits of each Member of a Parntership Firm/Co-operative Society etc.]