DISTRICT INDUSTRIES CENTRE
Government of Andhra Pradesh APPLICATION
FORM FOR THE EDUCATED
UNEMPLOYED YOUTH UNDER
"PRIME MINISTER'S ROZGAR YOJANA" SCHEME |
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| Name of the Bank/Branch |
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| 1. |
Name of the Applicant |
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| 2. |
(a) |
1.Name of the Applicant |
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(b) |
Husband's Name |
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(In case of married women) |
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| 3. |
Date of Birth and Age |
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| 4. |
Detailed place of Residental during last three years |
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| 5. |
Qualifications |
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(a) |
General |
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(b) |
Technical |
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| 6. |
Employment Regn. No. & Date if any |
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| 7. |
Whether the applicant belong to SC/ST/BC/Min/PH/Service/
Business /Women |
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| 8. |
Type of Industry/Service/Business activity |
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| 9. |
Present annual income of the family duly supported by proof |
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Rs. |
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Amount of loan required for |
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(a) |
Machinery & Equipments |
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Rs. |
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(b) |
Other fixed assets |
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Rs. |
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(c) |
Working Capital |
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Rs. |
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(d) |
Total |
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Rs. |
| 11. |
Whether taken loan from any Bank/ Financial institution, of State/Central Govt.
(Details in brief to be furnished) |
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| I certify that the above information furnished by me is true. |
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Signature of the applicant. |
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| Encl: |
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| Application in duplicate along with copies of following certificates: |
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| 1. |
Educational Qualifications Certificates. T.C/S.S.C/I.T.I |
| 2. |
Age certificate - TC -SSC Certificate |
| 3. |
Certificate of previous experience if any. |
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Physically Handicap Certificate if applicable. |
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Caste Certificate from Mandal Revenue Office, in the case of SC/ST or BC if applicable. |
| 6. |
Ex-Serviceman if applicable. |
| 7. |
Income Certificate from M.R.O./Gazatted Officer. |
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Ration card held by the family or residence certificate from M.R.O/Gazatted Officer |
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Affidavit on plain paper as enclosed. |
| 10. |
Recent Passport size photos(2) affixed |
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Eligibility: |
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| 1. |
8 th Class and Above |
| 2. |
18-35 years and 10 years relaxation for SC/ST/PH/Women/Ex-servicemen |
| 3. |
Family annual income below Rs.40,000/- |
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AFFIDAVIT
(On Plain Paper)
Not to be Notarized |
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I..........................................S/o.D/o.W/o.............................
Do hereby solemnly affirm and declare as under: |
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| 1. |
That I am Unemployed. |
| 2. |
That I am not in a position to muster my own capital for the Project. |
| 3. |
That I am a permanent resident of H.No............................................
Since .........................................years |
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That the family income of my family which includes spouse and parents
Rs.................... per annum from all sources such as salary, wages, agricultural income, business, rent, interest, pension etc., |
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That I have not defaulted in repayment of loan from any Nationalized Bank /Financial Institution, Co-op Bank. |
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That I shall abide by the rules framed under the scheme of PMRY for Educated Unemployed Youth. |
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That I shall submit the progress report required by the Bank/Govt. |
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That I am liable for prosecution if the furnished information is found false. |
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I or any members of our joint family have not availved any loan earlier from any Government Sponsored including PMRY |
| 10. |
had not applied for loan under PMRY to any other Bank. This is the only application now being preferred |
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| Deponent |
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| (Applicant) |
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| SPECIMEN COPY
(Candidates to obtain the below mentioned certificates separately) |
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| FAMILY INCOME CERTIFICATE |
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This is to certify that Sri/Smt................................................................,,
S/o, D/o, W/o ......................................................................................
R/o.H.No. .............................................. is residing in above Address and his/her
family annual income is Rs......................(Rupees....
...................................) |
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| from the following sources. |
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| a) |
Salary |
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Agriculture |
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Business |
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Rent |
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Pension |
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Others(specify) |
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I know him/her well with the best of my knowledge and hence this income Certificate is issued under G.O.Ms.No.554, dated: 2-8-1988 Revenue(A) Dept., and G.O.Ms.No.286, dated:28-11-1988, Social Welfare Department. |
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| Place: |
Signature of Gazatted Officer |
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| Date: |
With stamp |
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CASTE CERTIFICATE |
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This is to certify that Sri/Smt................................................................
S/o. D/o. W/o. ................................ of village/town ..........................
Mandal ...................................in the District of .............................. in
the State of A.P. has been verified as per the procedure laid down and he/she
belongs to ........................................ community, which is recognized as
Schedule Caste/ Schedule Tribe/Backward Class under group .......................
as SI.No............................................. |
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| Place: |
Signature of Gazatted Officer |
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| Date: |
Office Seal |
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| RESIDENTIAL CERTIFICATE |
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This is to certify that Smt./Kum./Sri.......................................................
S/o.W/o.D/o....................................R/o.H.No....................................is residing
in the
above address since.........................................years. |
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| I know him/her well with the best of my knowledge |
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| Hence this certificate is issued under G.O.Ms.No.554,dated 2-8-1988,Revenue (A) Dept., and G.O.Ms.No.178, Dated: 6-8-1988 Social Welfare (32) Dept., G.O.Ms.No.286, Dated:28-11-1988, Social Welfare Department. |
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| Place: |
Signature of Gazatted Officer |
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| Date: |
Office Seal: |
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