APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER (PMRY) PRIME MINISTER’S ROZGAR YOJANA
FOR UNEMPLOYED YOUTHS

      1.  Name of the applicant …………………………………………………………………………

2.  Sex (Male/Female) ………………………………………………………………………………

3.  Father’s /Husband’s Name ……………………………………………………………………

4.  Occupation of Father/Husband ……………………………………………………………..

5.  Address (Self)

a.       Permanent …………………………………………………………………………………….

b.       Whether Residing continuously ………………………………………………………….

In the area where from the loan applied for :-

6.  Age Particulars 

a.       Date of Birth …………………………………………………………………

b.       Age as on the date of applicant ……………………………………………………………

7.  Qualification

a.       Academic ……………………………………………………………………

b.       Technical ……………………………………………………………………

8.  Training received if any …………………………………………………………………………

9.  Whether the applicant is unemployed if so ………………………………………………..

     Whether the registered with Employment Exchange ……………………………………

10. Whether the applicant belongs to SC/ST/OBC …………………………………………

11. Type of Industry/Service/Business/Activity/Proposed to be set up/started

     (Give full  details).
       …………………………………………………………………………………………………………...

12. Previous experience of the line of activity ………………………………………………………

13. Proposed location of the unit ……………………………………………………………………..

14. Present annual Income of the family duly supported by the affidavit.
   ……………………………………………………………………………………………………………

15. Amount of loan required …………………………………………………………………………..

16. Margin Money Proposed to be invested ………………………………………………………...

17. Whether taken loan form any financial Institution Previously (give full detail)
     …………………………………………………………………………………………………………..

18.   I certify that all the information furnished by me is true and correct that no     barrowing/arrangements for the above
        proposed Industry/Service   /Business/concern with any bank/financial Institution made so far.

                                                                                                             Signature of the Applicant:

AFFIDAVIT UNDERTAKING

I ________________________________________S/o ________________________________________ R/o __________________________________________District _____________________do here by solemnly affirm and declare as under:-

1.       That I am unemployed.

2.       That I am not in position to muster my own capital for the project.

3.       That I am permanent resident of _________________________since _____________years.

4.       That family income which includes spouse in Rs………………………….per annum and income of my parents is Rs. …………………………per annum separately from all sources such as Salary, Wages Agriculture, Income, Business, Rent Interest, Pensions, etc.

5.       That I have not defaulted in repayment of loan from any nationalized ban/financial institution/cooperative bank.

6.       That I shall abide by the rules framed under the scheme of PMRY for Educated unemployed youths.

7.       That I shall submit the Progress report required by the bank/Government:

            Verification                                                                    Deponent

Verified that the above contents are true and correct to the best of may knowledge and belief and nothing has been concealed therein.

 UNEMPLOYED CERTIFICATE  

Certified that I _______________________________________________________________________
                     ( Name and Designation of issuing officer)

Know Sh. __________________________________S/o Sh. __________________________________ R/o __________________________________________personally for last _____________________ years. He is not serving in any Government Semi-Govt. Deptt/Under taking/private establishment. He is neither engaged in any gain full vocation on profession nor carrying any business in his or any relative name:He is not on rools of any educational institution.

Date:-                                                                           Signature of the
Place:-                                                                         Gazetted Officer

Income Certificate

            It is to certify that over all family income of Sh. ________________________________  father of Sh.________________________________R/o________________________________ Tehsil  is Rs.___________________________________per annum from all sources.
                                                                                                                                                         Signature and Seal
                                                                                                                                                    Of the Gazetted Officer

Other formalities in duplicate and duly attested

1.       Qualification/ Date of Birth Certificate

2.       Photographs.

3.       Ration Card, Copy

4.       State Subject