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Application No:
(for office use)
6 Sex(Women/Transgender)
10 Aadhar Number
Hindu/Christian/Muslim/ Others(Please
12 Religion
specify)
SC/ST/BC/MBC/OC(Please specify the
13 Community
subcaste)
14 Educational Qualification
Occupation
(Private/Govt. aided organisation or project/CBOs/shop
15
establishment/Domestic help/self-employed/Banking
correspondence/ASHA workers) Please specify
17 Annual Income
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Amma Two Wheeler Scheme Application Form 2017-18
a)Type of the Vehicle proposed to be
purchased (Non-Geared / Auto-Geared upto
125cc alone are permitted)
19
b) Total cost of the vehicle as per invoice /
quotation (on Road price)
a) Does the beneficiary propose to buy the
vehicle from her own funds or through loans
from Bank / Finance institutions? (Please
specify)
b) Enclose invoice quotation for the vehicle to
20
be purchased.
b)Bank name
c )Branch
d)IFSC Code
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Amma Two Wheeler Scheme Application Form 2017-18
24 Copy of Documents to be enclosed
a Aadhar card
b Driving License
c Community Certificate (incase of SC/ST)
d Proof of Education (8th pass/fail)
e Proof of Employment
Salary Certificate from Organisation/
f Employer's Certificate/Self declaration for self
employed
Bank Pass Book First Page with Account No. &
g
IFSC code
h ID Card from Organisation, if available
Proof for claim under Priority category as
i
mentioned in S.No.24
Invoice / Quotation for the vehicle to be
j
purchased
Declaration:
1. I declare that all the information & documents submitted by me are true to the best of my
knowledge
2. I voluntarily agree to share my Aadhar number for availing the subsidy given by the
government for the purchase of Auto geared/non-geared motorised two wheeler.
Date:
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Amma Two Wheeler Scheme Application Form 2017-18
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