SPICES BOARD Office use only
Name of the unit
(Ministry of Commerce & Industry, Govt. of India)
Sl. No.
N.H. By-Pass, P.B.No.2277, Palarivattom, P.O.,
Date of Receipt
Cochin-682 025
APPLICATION FOR AVAILING ASSISTANCE FOR PURCHASE OF SEED SPICES
THRESHERS FOR POST HARVEST IMRPOVEMENT OF SEED SPICES
1. Name of the applicant
(In block letters) :
2. Father's/Husband's name :
3. Name of the Contact Person and
his designation in the case of group / NGO :
4. Name of the Guardian if the applicant :
is a minor
5. Registration Details of Group / NGO :
6. Gender : MALE/FEMALE
7. Age of the applicant :
8. Category : SC/ST/GENERAL
9. Postal address with Pin code to which :
communications are to be sent
with Tel/Fax/e-mail
10. Details of the plantation/farm
a. Sy. No: b. Village :
c. Location: d. Taluk
e. District f. State
11. Tenure of land : Patta/Lease/Possession
12. Total Area : ha
13. Area under seed spices : ha
Copy of documents to be attached:
1. Copy of the land document, 2.ID Proof (Voter ID card), 3. Bank Pass book, 4. Quotation. For Growers groups/ Associations/ NGOs / SHGs registration details,
list of member growers, land details of each grower, crop grown, area, Original documents should be produced at the time of submission of application for
verification
14. Details of the present facilities available :
for threshing ( please specify the capacity)
15. Details of the Proposed seed spices thresher
(Please attach quotation from the
approved source)
a. Name & address of the approved supplier :
b. Capacity :
c. Total Cost of the Unit (including VAT) :
16. Details for e-payment of eligible subsidy
a) Name of the Bank :
b) Branch name with IFS Code No :
c) Account Number :
d) Type of account : Savings/Current/Cash credit
DECLARATION
1. I declare that the particulars given by me in the above application are true to the best of my
knowledge and belief.
2. I shall abide by the terms and conditions stipulated by the Spices Board from time to time for availing
the subsidy.
3. I shall use the seed spices thresher over a period of time.
4. I undertake that in the event of any amount paid to me in respect of the unit supplied under the
program becoming recoverable, I shall refund such amount in lump sum with interest applicable from
time to time to the Spices Board on demand in writing by the Board.
Place :
Date : Name and signature of the Applicant
_____________________________________________________________________________
FOR OFFICE USE
Copies of the attached documents are verified with original and found correct.
Date:
SIGNATURE:
NAME :
DESIGNATION:
Copy of documents to be attached:
1. Copy of the land document, 2.ID Proof (Voter ID card), 3. Bank Pass book, 4. Quotation. For Growers groups/ Associations/ NGOs / SHGs registration details,
list of member growers, land details of each grower, crop grown, area, Original documents should be produced at the time of submission of application for
verification
PRELIMINARY INSPECTION REPORT
1. Date of Inspection :
2. Area under Seed spices : ha.
3. Anticipated seed spices production during
current season : tones
4. Necessity and Technical Feasibility :
5. Recommendation of the Inspecting Officer :
Date :
Place : Signature
(Name and designation of Inspecting Officer)
Seal
Copy of documents to be attached:
1. Copy of the land document, 2.ID Proof (Voter ID card), 3. Bank Pass book, 4. Quotation. For Growers groups/ Associations/ NGOs / SHGs registration details,
list of member growers, land details of each grower, crop grown, area, Original documents should be produced at the time of submission of application for
verification
