ANNEXURE-I

(Documentation Form for Sanction of chaff cutter)

Name of the Scheme: Photo of Beneficiary

to be pasted duly
Details of beneficiary
attested

• Name of the beneficiary:

• Father/ Husband Name :
• Village :
• Mandal:
• Caste ( SC/ST/ OC/Min/ BC):
• Category( SF/ MF/AL):
• Gender( M/F):
• Member of SHG or not :
• Aadhar Card No.:
• White Card No.:
• Nearby by Veterinary Institution:
• Details of land available for cultivation of green fodder:
Other Details:
• Whether the beneficiary is experienced in dairying:
• No. of livestock possessed by the beneficiary:
Scheme details:
• Unit cost :
• Subsidy :
• Others if any:
Declaration by the beneficiary
I declare that the above information provided by me is correct.
Date:
Place:
Signature of beneficiary
Approval of the Committee

Certified that Sri/Smt ________________S/o,W/o __________________

belonging to …………………………………………Village………………………..Mandal………………………. is
herewith selected for supply of chaff cutter under _____________scheme during 2015-
16 and paid the Non subsidy amount of Rs…………………Only.

Signature of the VAS /Signature of AD(AH) / Signature of DVAHO /