Application form for Financial Asssiatance under Chief Minister's Rozgar Yojana
1. Name of the applicant (in block letters):
2. Sex (Male / Female):
3. Father's name / Spouse's name:
Occupation:
Address:
4. Address (Self)
	a) Permanent:
	b) Correspondence:
	c) Whether residing continuously for the last three years in the area from where loan is applied:	Yes/No
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 and duration):
8. Whether the applicant is unemployed? If so, whether registered with the Employment Exchange: (Give Registration No. & date):
9. Whether the applicant belongs to SC/ST/BC: Ex-serviceman / Handicapped / Woman / Etc.
10. Type of industry/service/business activity proposed to be started: (Give project details in the attached proforma):
11. Previous experience in the line, if any:
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 duly supported by the affidavit:
14. Amount of loan required:
	a) Machinery & equipment:
	b) Other fixed assets:
	c) Working capital:
	Total:
15. Margin money proposed to be invested:
16. a) Whether taken loan from any banking/financial institution of State/Central Govt.:
	b) If yes, for 16(a) whether all repayments made:
	c) If no, for 16(b) indicate the balance amount:
	d) Bank Account Details:
17. I certify that all information furnished by me is true and that I have no borrowing arrangements for my above proposed industrial / service / business concern with any bank / financial instituion.
	_____________________ Signature of the applicant
Note:
Application should be submitted complete in all respects in duplicate alongwith attested copies of following documents:
1. Age certificate;
2. Certificate of qualification - academic and technical
3. Ration card/residency certificate from Taluka Mamlatdar for 15 years.
4. Experience certificate, if applicable.
5. Affidavit duly countersigned by the Executive Magistrate/Notary/Oath/Commissioner, etc.
6. No Objection Certificate from owner of premises )place of setting up of business) or lease agreement in case of rented premises.
7. Quotation, for supply of machinery, raw materials/other items, etc.
8. All Xerox copies should be attested.
9. Both applications should carry latest photo of applicant.