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1. Date of Submitting Application :
( Date/Month/Year)
2. General Informatiom :
i. Village Name :-
..
ii. Sub-division Name :-
..
iii. District Name :-
...
iv. Name of Representative of Village Society :
.....
v. Place of the Proposed Schemes :
.
vi. Name of NGO/Sericulture Cooperative Societies to be attached Proposed
Schemes
.
vii. Name of Representative NGO/ Sericulture Cooperative Societies
......
....
viii. Population of the Village
...............persons
ix. Total Number of Household in the Village
... households
3. Proposed Land :
1. Acquisition of Land to be Used for the proposed Schemes :
1. Present land ownership and /or tenure system;
o Community land of Village Society
..
.ha
o Land under Management of Dept. of land revenue
..ha
o Other ( Private land/ Patta land
etc)
........ha
1. Certificate to land Use
o Certificate or authority for the above land use shall be attached here to
2. Distance from home village (km)
.. km.
4. Proposed Field Operation Unit (FOU) :
1. Total Number of FOUs
.. groups
2. Total Number of Beneficiaries
.persons
3. List of FOU and Meeting Record and /or agreement
o List of FOU and name of group leader shall be attached hereto
o Meeting record and or agreement in the Village for the FOUs shall be attached hereto
Signature of Representative
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