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Form I

This document is an application form for the creation of a new IFMS ID for dealers in Odisha's agriculture sector. It requires detailed information about the dealer, contact details, sale point address, and bank account information, along with mandatory attachments. The form must be filled digitally and submitted to the Block Agriculture Officer for processing.

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129 views2 pages

Form I

This document is an application form for the creation of a new IFMS ID for dealers in Odisha's agriculture sector. It requires detailed information about the dealer, contact details, sale point address, and bank account information, along with mandatory attachments. The form must be filled digitally and submitted to the Block Agriculture Officer for processing.

Uploaded by

adas20242
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

FORM-I

Government of Odisha
Department of Agriculture and Farmers, Empowerment
Application for Creation of New IFMS Id
A. Dealer Details
1 Dealer/ Agency Name
(As in LoA)
2 Dealer Type
(Wholesaler/ Retailer/ Marketer)
3 Dealer Nature (PACS/ Private/
Manufacturers’ Outlet/ Others)
4 LoA Number

5 LoA Valid From


6 LoA Valid Up to
7 PAN
8 GSTIN (Mandatory for
Wholesaler & Marketer)
B. Concern Person/ Owner Details
1 Person Name as per LoA
2 Person Name as in AADHAR
(To be entered in IFMS portal by the District
LFS)
3 Person Designation
C. Contact Details
1 Primary Mobile 2 Alternate
Mobile
3 E mail address
D. Sae Point Address
1 District 2 ADO Circle
3 Block 4 GP/ ULB
5 Village/ Ward 6 Pin
7 Land Mark
8 Latitude (In 9 Longitude (In
decimal up to 6 digits) decimal up to 6 digits)
E. Dealer Bank Account Details
1 Bank Name
2 Branch Name
3 Bank Account Number
4 IFSC
5 Account Holder Name
(Shall be in name of the Dealer)

Signature with Seal of Dealer


Page-1/2 (PTO)
NB:
1. All the fields are mandatory
2. The form shall be filled up by digital typing. No hand written application
shall be accepted.
3. Self-attested Copy of LoA, PAN Card, AADHAR, Bank Pass Book, Geo-
tagged Photograph of Sale point address & GSTIN (For Wholesaler/
Marketer) shall be attached along with this application.
4. The application shall be filled in all respect by the dealer and to be
submitted to the Block Agriculture Officer.

FOR OFFICE USE ONLY

Memo No: Dt:


1. The information provided by the Dealer was verified &found correct.
2. The Dealer Does not possess an IFMS Id prior to this application.
3. The dealer does not possess multiple LoA.
4. Applicationforwarded to the ADO for kind information and necessary
action.

Seal & Signature of BAO

Memo No: Dt:


1. The LoA of the dealer is not under suspension or cancellation.
2. No LoA other than the aforementioned LoA exists in the name of the
dealer/ Person.
3. Application forwarded to the CDAO for kind information and necessary
action.

Seal & Signature of ADO

Memo No: Dt:


1. From the IFMS Portal & E-Licensing portal it is confirmed that no IFMS Id
exists in the name of the Dealer prior to this application.
2. Application forwarded to the District LFS for creation of the IFMS ID for
the dealer.

Seal & Signature of CDAO

Page-2/2

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