Government of India

Ministry of Fisheries, Animal Husbandry & Dairying

Department of Animal Husbandry & Dairying

NATIONAL LIVESTOCK MISSION

(APPLICATION FORM FOR ASSISTANCE UNDER DIFFERENT SUB MISSIONS OF NATIONAL LIVESTOCK MISSION)

PHOTO

SIGNATURE

1. Sub-Mission for
assistance
2. Activity
3. Applicant Category
4. Applicant Details
4.1 Name
4.2 Address
Address Line
City/Town District
State Pincode
Landmark, if any

4.3 PAN No* 4.4 CIN (in case of company)

4.5 Existing Credit facility Bank Name Branch Name Type of Facility Sanction Amount
details (if any)

5 Details of Key Promoter

5.1 Name

Father’s Name/
5.2 5.3 Mother’s Name *
Husband’s Name *
General/ SC/ ST/ Male / Female/
5.4 Category* 5.5 Gender (in case of individuals)*
OBC & others Transgender

Page 1 of 4
 PAN No* Aadhaar No*
5.6 KYC

6. Experience in
Livestock Farming
<100 words>
7. Educational
Qualification
8. Whether attended any Name of Course Name of institute Duration Year
Livestock Farming
related trainings (if yes,
give details)
9. Annual Income from
Agricultural/Business
activities

B. Project Details:

10. Brief description of the proposed project including expected output of the project* (200 words)

11. Address / Location of Proposed Project Site*

Address Line
City/Town District
State Pincode
Landmark, if any
GIS Location Longitude Latitude

12. Status of Land Owned <Radio Button> Leased <Radio Button>

Number of
13. employees proposed
in project
Number of small
14. farmers proposed to
be integrated

Page 2 of 4
 15. Cost of Project :
A. Cost of Animals/ Birds (As per DPR) :
Description of Animal Number of Animal/ Bird <X> Cost per Animal/ Bird <Y> Total Cost <X*Y>

Sub Total
B. Cost of Civil Construction/ shed
C. Plant & Machinery
D. Any Other Component
Total Cost of Project (A+B+C+D)
16. Means of Finance :
<Project with own sources> <Project with bank loan>
A. Applicant’s Share
B. Subsidy Amount
C. Bank Loan Amount
Total Means of Finance
(A+B+C)
Whether subsidy for
17. this purpose has been Yes No
availed earlier?
Source of beneficiary’s
18.
share
19. Preferred Bank Details for Loan Application:
Name of the Bank Bank Branch IFSC Code

C. Details of Applicant Bank Account (For release of Subsidy) :

20. Bank Account Bank Name Bank Branch with complete address Bank Account Number
Details*

Branch IFSC code MICR Code of Bank Any other relevant information

Declaration and Authorization :

 I, hereby certify that all information furnished by me/us is true, correct and complete. I have no borrowing arrangements except as
indicated in the application form. I have not applied to any lending institution. There is/are no overdue / statutory due owed by me. The
information may also be exchanged by you with any agency, you may deem fit. You, your representatives or MoFAHD, or any other
agency as authorized by you, may at any time, inspect/ verify my/our assets etc. You may take appropriate safeguards/action for
recovery of lending institutions’ dues.

 I have no objection to authenticate my Aadhaar number, share the same with other Ministries / Departments under the Government of
India for the purpose of extension of benefits under any of their Schemes, carry out e-KYC and accessing my credit history & credit
score by credit bureau, lenders and their authorized agents. The consent and purpose of collecting Aadhaar has been explained to me/us
in local language. MoFAHD/ Lending Institution has informed me that my Aadhaar submitted herewith shall not be used for any
purpose
other than mentioned above, or as per requirements of law. I have been informed that this consent and my Aadhaar will be stored along
with my account details with MoFAHD.

I Agree to the Declaration & authorization.

Page 3 of 4
Date : ____________________
Place : ____________________
Signature of Applicant(s)

**************************************************************************************************************

Page 4 of 4