eTracking Applicnt ID: KBAS17185845-5022848

Office Name: KVIB-GOLAGHAT-AS Agency: KVIB

1. Aadhaar Number : 2. Legal Type : Individual

3. Applicant Name SHRI BILPAB MORANG

4. Gender : MALE 5. Date of Birth : 24-Jan-1986 Age 32 Yrs.

6. Social Category : Scheduled Caste 7. Special Category : North East Region

8. Qualification : 12TH Pass 9. PAN No. : CNIPM9904Q

VILL NAMTEMERA, PO MOHURAMUKH

Address for Communication:
BOKAKHAT

10. District: GOLAGHAT Pin Code: 785619

State: Assam E-mail ID:

Mobile No.1: 9101351826 Mobile No.2:

VILL NAMTEMERA
Address of Proposed Unit:
PO MOHURAMUKH
11.
District: GOLAGHAT Pin Code: 785619

State: Assam Unit Location : Rural

12. Type of Activity : Service AGRO AND FOOD

Mini rice shelling unit/Rice Mill

13. Name of Activity :
SEEVICE

14. Whether EDP Training Undergone : No 15. Institution Name

16. Preferred Agency: KVIB

Capital Expenditure: 300000

17. Loan Required Total: 500000
working Capital: 200000

UNITED BANK OF INDIA

1st Financing Bank Name and KAMARGAON

18.
Address Kamargaon, Golaghat, City : Golaghat, State : Assam, Pin : 785619

GOLAGHAT IFS Code: UTBI0KMGG39

19. Alternative Bank IFS Code:

I, BILPAB MORANG Certify and declare that all the information provided above is true and correct. Any information that may
be required to be verify, shall be provided to the concerned authority.

Online Submission Date:27/11/17 1:32 PM Signature of Applicant

Report Print Date: 2018.March.15 AD 01:06 PM Page 1 of 1