sper one Gpiyfo exmmfasgiemp wore Qgmfled end Application SI.No. UYEGP SCHEME) hp Camenip Qnaetaesisrer Cosme auminny 2 andes Gi set 2 505 eSleinssmnnd APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER UNEMPLOYED YOUTH EMPLOYMENT GENERATION PROGRAMME UYEGP Regn.No. (Office use only) Alix Recent Passport Size Photo adie eGdatuce arent ray tyenluna gta airemtpray CauT (Name of the Applicant in block letters) 2 : aysior Qusier Qin: Sex (Put “Mark) Male Female Sopris, Transgender Siienploomran Chaat 7 Father's / Husband's name [ Gahan Campa (paar Occupation (Yanan) Address (Self 2) Sibgsr (pesoufl [Permanent Address by sens) opr Cousiongws aewrerd Correspondence Address sul 1h / Taluk Mobile No./Email ID if any. WardNo. 2) SLs ont ays Osan Gsm As . : cikioroMT IGGL UGH) sucFysgy yn Qaionen aug Sif ? Yes No Whether residing continuously forthe last three years in the area from where loan is lied (put Mark) Age Particulars ; pT Tate of Birth => og Religion Month axgLin] Year Spier wet Spo Age as on the date of application ________Years sa (466) [Qualification maine a) seiaSl euusbguoten / Academic b) 1 Technical Technical Ig TOSAIGUMAT aise Tus Training undergone, if any Name of Inst (give name of institution & duration of training) [ Duration, Camadergant? oplanpnilar “ay | Gbones C) ay era ula, oot a mua Carenarauni’n syne Yes/No Sp Gp Corsi UBiigssi ian? (Put mark) Wiather the applicant is unemployed? 0, | yBlay eto “) eae Soon Registration No. ange? (Give registration No & Date) gaot 7 Date Sarampant Sorat upp xi camet srgpusudSort hon ys Upnigpiieri/anRSalspuretmasiniiyg | sc | sx | ec | wo | ol} emir, | 8 | aosy | Zane Gender Spomnefisst/ Sepnisosust Whether the applicant belongs to ‘SC/STIBCIMBC/ Physically Handicapped / Exserviceman/Minority/Transgender (Put ¥ Mark) 10. ‘GUI BUH One Cat Name of Venture Gaiion Taxes [Category (Puty Mark) | pnp Gaebe Industry Service Shura Business 1. ya spied aguniaSat Sans Previous experence nthe line of activity, any oan ona PeersacksTE] ana O-S GRAIL Oanpinn ais Tera eT BL GB 2 ci sifiesi ? (pag alam, au! Soot Quugst) Place of work where the activity as mentioned in Colmn. 10 is proposed to be started (Give full details with name of Taluk) 73. | GOLbu gist augue A Cup SME ott Slseror Ses GassinA) Present annual Income of the family duly supported by the Affidavit s-(per annum) | *9® Ge usin imewdners 14. |ProjectQutlay Cgeoaxii@io use OS Opsrenes |: Gui garam. nist Machinery & Equipment (a) isn ojereus Gong Other fixed Assets b) ‘Ser. pon epeopamlu Working Capital (c) sess yen ch Er (Refer para 1 of instruction sheet enclosed) 75._| Project Cost - Funds Pattern 8) SLL Shi aan (yp ps) iE’ OS Opsreos, ‘Owners Contribution proposed to be invested 5% to 10% of Project Cost b) BCL utah ge) wrefiud axmmupacer 65 15% Subsidy @ 15% of Project Cost. ©) acti Gsrenes Loan Amount 6) Guanggib Total 16. | 9) Baie wot anid ToRp Cop anble owe enies 69 Sassi aati ax gus Guster? Yes NoL Whether taken loan from any banking / financial (un) @sison) Institution of State / Central Govt. (put_¥ Mark) B) arian ota xiii, seo SGT Gages ella for 16 (a, whether ale made TFatanp aca a Baron Gpseas If yes for 16 (a), indicate the balance amount TT] Bane wat wretuggs oo ong oot CLippaurn ? Whether availed loan under subsidy linked Yes No O Govt Scheme? (uy @Qeicon) Tigi duet Saaign aon ca CSA OMa Compan game amdwat qaton 1 HT Brnvernisafat epson x spys68l 1g Gum sTdLUMH Geuiwssledeoe sroragh enti pana. Certify that all information furnished by me and true and that I have no borrowing arrangements for my above proposed industrial service / business concern with any bank | financial institution, BLid (Place) : aSloreentugst 60Gb sbieir (Date) Signature of the Applicant Ch: gigi Clu Si Accs esc. Gace HeirenubAHOD aoe SL OaD f6 GAA Gaier jammiattet pademer Gwerbs Often (3) gine cyauoralas Gung! Gooreri, ura. Opnped coor, 2,078 688). oust SITES, Carenau - 641 001, eure w opis Garston rd. ® FOR OFFICE USE ONLY Recommended Bank Recommended by Task Force Committee held on ‘Activity (Industry | Service Business : Projecicost "RS. Rupees, SUBJECT TO THE CONDITIONL] of getting Proforma—Invocie 1 of confirming The genuinity of Supplier [-] of geting affidavit, confirming residency of candidate for alteast three years {O és Chairman TASK FORCE COMMITTEE ‘Signature of TFC Members ee once COTTE @ Amendment made by GM, DIC | © “Amendment by Task Force Committee ‘Change of Bank effected to Amendment approved by TFC held .. Applicant's / Bank/s Lr (as Per BM's Lr.No. 41. Activity changed to .. 2. Amount changed to Rs. Chairman / TFC @ Revalidated for the year. ‘TFC Member's Signature Chairman /TFC GM, DICAFFIDAVIT 218) Comp upend . S/o.D/o. Wio..... Rio... ..District/State .. do hereby solemnly affirm and declare as under: (1) that | am unemployed (2) that | am not in a position to invest for the project by myself (3) that | am permanent resident of since.. year (4) such as salary, wages, agricultural income, business, rent, interest, pension etc. (5) that | have not defaulted in repayment of loan from any nationalized bank / financial institution / Co-op Bank. (6) that | shall abide by the rules framed under the scheme of Unemployed Youth Employment Generation Programme (UYEGP). (7) that | shall submit the project report to the Banks / Govt. DEPONENT (eos Quits) VERIFICATION Verified that the above contents are true and correct to the best of my knowledge and belief and nothing has been concealed therein. Date ... DEPONENT warts) Note: This affidavit should be furnished in Rs.20/- non judicial stamp paper duly attested by Oath Commissioner (Notary Public) at the time of loan sanctioning by the bank.UYEGP up55 Gasmnoouyn Ramgtec,dere Cameamity letter Ligeuri sane LTA Qaulexsyh sure ay 1 centr, Gieonis wero Bram ui Cami say_at Buetnygyas Sa MaCuyssL Casir 2 a, [nL Ops pie ceieeeiuprnt caine Of ops SMSO? 118 cag ys ganas Hoppe) Camb eh a OGis syst tb; | &1/50,000/- Hams} Gadse opuFush 4 [Bonie: | cerantusmt GapisutAd pnb SedramiAto use waigi : Casi Guu EOL Boos uvosse epatg Cod ewig aGaUBS omar, 2656) oresigefb DOLLS oraipey Guppipas Coming. Sevawe 6S ‘aces ‘pulser ‘Gaertn auat asp ant Gup amitiyierg. sBoftays Opens: 9 $11 Siierer (ypatCigsd Alf ys Qprons 10% — Curgesifoyat, Q5%-, AigeigyuSent/ sat J yu mat oman / SpuGiapLxL exter / fsa SiGe. mgident | gaiemst Grapespent | unigybespenelact / Sopriasust. 8 BASED anihikg URigerscuph uguiigianisl sa UspA agiusat > | Giuahty gymam (Sanction Crue eat A Come arti (nus at) fay uggs, Cova umurph emis Business & Served Sie LepeTEDRe, 7 priact Stare UdipA ura Ogmied auusgord opfiate Usps Uisarh gphuuorergs 7. Sainemiugmnt SYuspA nears Au Gams Gedung, anid Ups ‘ooere, mat Gr nctitr oie Be fat af up Gwarg. 8. usu upgr unpo greet end Mer SLLS Sat Sy oveefinsse ot Heys ex spafl Cuppigiier HA FHe a gpGup Huerg Seoiiynnh Gear Gide Gite war gSehl ipsudshle) esitereumyy e-20/— 2 pesCuump Liss : opbeepene pide alg Opera dete (Notary Publig maGuriuh Guig, svat eipiign Gurg amdise Salinad Gla nh genes eieeiees eeaaa een ti : gale Lepr oF UfQEd pHa aSaroLRisenL ar Beramtaysct : Ajasain. syamemincer Qmenrhg) ures’. Csnpat ena stynns fio flere’ say stat et gan pig erent Bh it ener Oo peste) et Lope we) epi sea Bionpaton srPad pri iakg OypucL Heh enatyShoy Sapresare : ; a) Lt COMMITTEE) eipaxh Gupufiiguor Qenturiu(part. General Manager, District Industries Centre, Door No.141, College Road,Opposite to Iyyappan Temple,Tiruppur-641 602.