`
ంణ పభవ ం
జ య ం థం / RAJIV YUVA VIKASAM SCHEME
Application No: ఖ మ /Application form
(SC, ST, Minorities, Christian, BC, MBC, EBC Corporations and Federations)
1. ొ న /
Corporation Name :-___________________________________________
2. ా /
District :-___________________________________________ ఖ
3. ంం/ ఫట
Mandal / Municipality :-___________________________________________
4. గ/
Village / Ward :-___________________________________________
5. అగ /
Address : -___________________________________________
6. మబల ం./ Mobile No :- 1) 2)
ఖ / Applicant Details
7 ఆ ం.
Aadhar No
8 ఖు (ఆ గం)
Name of the Applicant (as per Aadhar)
9 ంగ / ు
Father / Husband Name
10 ం (ష / సరు / గన జం)
Gender (Male / Female / Transgender)
11 ి త /
Date of Birth / Age
12 హ
Educational Qualification
13 న / ఆ గ ం.
Ration / Food Security Card No.
(/ OR)
ఆ ృవ గం ం.
Income Certificate No. (Mee seva)
14 ం ఆ
Annual Income:
15 ృవ గం ం.
Caste Certificate No. (Mee seva)
16
Caste
17 ఉ
Sub-Caste
18 ృ
Occupation
19 ే ల గూప / Vulnerable Groups
20 ం ృవ గం ం.
Differently Abled Persons No.
21 ి / Sector : ☐ ం / Agriculture
☐ గ / / ం / Industrial /
Service / Business ☐ ఇ / Others
22 థ
Scheme Name
23 యట (. )
Unit Cost (in Rs.)
24 ఆ ి హం ం /
Type of Financial Assistance
న ంక ం / Non-Bank linkage
ంక ం / Bank linkage
25 ి క ం.
Pattadar Passbook No.
26 భ రు ణం (ఎ., ం.)
Land Details (Acres. Guntas.)
27 ంక / BANK DETAILS
ం
Bank Name
గంచ
Branch Name
ఐ.ఎఫ.ఎ..డ
IFSC Code
న ం.
PAN No.
న ఇంం ధృన . ఐ ం ల
ం భ ొ ష / పభవ ం ం ఎం బ డ ం క
పన ., ఏద ం ొ తత, సరష
ే ు ధ హ య ొ ష
/ పభవ ం చే అంగన .
I, hereby declare that the above details are true. I also declare that neither I nor my family
members have availed any subsidy from Corporation / Government in the past five years If any
information is found incorrect, my registration is liable for cancellation and I am liable for any action
taken by the Corporation / Government.
ఖ ం
Signature of the Applicant
:
1) ఆ 2) ృవ గ 3) ఆ ృవ గ / ఆ గ
అ ంంధ ృగ : (ం ృ గం / హ / ఏద
సం ం ృ గం/ సైం న ( ంం))
Note: Candidates shall submit filled Application form along with required documents in concerned Mandal
(MPDO Praja Palana seva kendralu)/ Municipal office.
గమనక: అభయ రు ంచ దఖ ఫమన అ తా ట ంబంధ ండం (MPDO
తజ సవ కంతదం)/ ల య ం ప ం.
