eTracking Applicnt ID: KVAS181912-8328211

Office Name: ASSAM-SO Agency: KVIC

1. Aadhaar Number : 2. Legal Type : Individual

3. Applicant Name SHRI TAFIQUR RAHMAN

4. Gender : MALE 5. Date of Birth : 01-Jan-1987 Age 31 Yrs.

6. Social Category : General 7. Special Category : North East Region

8. Qualification : 12TH Pass 9. PAN No. : BIIPR3942M

VILL- DOLOITOLA
Address for Communication:
PO- SANIADI, PS- HAJO, BLOCK- HAJO

10. District: KAMRUP Pin Code: 781102

State: Assam E-mail ID:

Mobile No.1: 8876901817 Mobile No.2:

VILL- DOLOITOLA
Address of Proposed Unit:
PO- SANIADI, PS- HAJO, BLOCK- HAJO
11.
District: KAMRUP Pin Code: 781102

State: Assam Unit Location : Rural

12. Type of Activity : Manufacturing REBT

Wood Work
13. Name of Activity :

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

16. Preferred Agency: KVIC

Capital Expenditure: 250000

17. Loan Required Total: 700000
working Capital: 450000

ALLAHABAD BANK

1st Financing Bank Name and HAJO

18.
Address VILL P O HAJO DIST KAMRUP ASSAM PIN-781102

KAMRUP IFS Code: ALLA0210291

19. Alternative Bank IFS Code:

I, TAFIQUR RAHMAN 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:13/8/18 10:48 AM Signature of Applicant

Report Print Date: 2018.November.05 AD 11:34 AM Page 1 of 1