FORM AG-111 (This form is issued free of charge)

Serial No.

BANK OF INDIA
Photograph of the Applicant

APPLICATION FORM FOR DEVELOPMENT OF DAIRY FARMING (COMMERCIAL) The Manager, Bank of India, ___________________ Branch. Dear Sir,

I/We hereby apply for a loan of Rs.________________ (Rupees ___________________ ________________________________- only) from the Bank for the purpose of dairy development.
Necessary particulars in this connection are given below : 1. Name & address of the applicant(s) : (in case of firm/company indicate the name of the firm/company and its partners/ directors & enclose balance sheet, if available). (a) Name in Full 1. 2. 3. Permanent Full Address (b) Status (Whether Individual/Joint Hindu Family/Partnership) (c) Whether scheduled caste/tribe Fathers/Husbands name Age Total Net Assets

: : :

2. Applicants aptitude for and experience in this business : (Indicate the qualification/diploma, if any, and whether undergone any training, etc) 3. Objective of the Scheme : (Indicate nature of development whether setting up of new dairy farm and/or expansion of existing one) 4. Location of the existing/proposed dairy farm: (a) Address : (b) Distance from the Bank (Km.) (c) Mode of transportation (d) Whether skilled labour available (e) Other particulars to justify location nearness to market, climatic factors, etc.: : : :

5. Particulars of the Existing Dairy Farm -------------------------------------------------(a) Land (b) Buildings (c) Milch Cattle No. Breed

Area/Built-in area -----------------------

Capacity Approximate Value (Rs.) ------------ -------------------------

-------------------(i) Buffaloes (ii)Cows (iii)Others

Average Average Average Annual Net Lactation daily per lactation Income Period milk yield milk yield (Rs.) (days) (litres) (litres) ------ ----------- ------------- -------------- ----------------- ----------------

6. Cost of the proposed schemes : A. Fixed Investment ------------------------------------i) Land (in hectares) ii) Buildings (a) Cattle shed (b) Feed Godown (c) Processing Unit (d) Others (specify) iii) Equipments/Machinery (a) Dairy Equipments (b) Feed mixing unit (c) Others (specify) iv) Purchase of Milch Cattle : (a) Buffaloes (b) Cows (c) Others (specify) v) Development of farm yard/ grazing yard (indicate nature of development) B) WORKING CAPITAL :

Proposed _______________________________________________ Built-in Capacity/ Unit Cost Total Cost Area Number Rs. Rs. ---------------- --------------- ---------------- -----------------------

Number

Breed

Average Total Unit Cost Total Cost quantity Quantity Rs. Rs. per animal ------------------ ------------- --------------- ----------------

(a) Cost of feed (b) Cost of fodder (c) Other expenses Total Grand Total (A+B)

7. Source of Finance

Total Cost of scheme Rs. -------------------

Own contribution Rs. ------------------

Loan amount required Rs. ---------------------

(a) For Fixed Investment (b) For Working Capital Total 8. Economics of the scheme (Economics of the scheme should be worked out for the entire loan period and should be enclosed in statement form enclosed) A. INCOME Sale of milk Sale of calves/redundant Animals Others (specify) Gross Income B. EXPENDITURE Cost of fodder Cost of Feed Others (specify) Total _______________________________________________ Net Income (A-B) 9. Repayment of Loan Mode of Repayment : : _______________________________________________ Existing -------------------For the last year --------------------Qty. Value Rs. Rs. ------------------------ -------- -----------Unit Price -------------------Proposal ------------------------For the year after implementation ---------------------------Qty. Value Rs. ---------- ---------------

Number of Instalments : Amount of Instalments : 10. Securities : Existing (Indicate the basis of Rs. of valuation and nature of ------------title, particulars of encumbrance if any, etc.) i) Dairy Farm : a) Land : b) Buildings : c) Equipment & Machinery d) Milch Cattle : ii) Others Securities (specify) Land Buildings : : Location Cost Price Market Price Nature of Rs. Rs. Title -------------- ---------- -------------- ---------------- -----------Area Assets Proposed Total Nature of Title Rs. Rs. ----------------------- ------------- ------------------

iii) Total value of security offered to the Bank (total of (i) & (ii)) iv) (a)Guarantors, if any

: : Business/ Total net Guarantees given Occupation assets other than the Present one -------------- --------- ---------------- ------------- ----------------------Name/ Address Age

(b)Guarantees given

: Name/Address of the person Amount/Date for whom guarantees are given ------------------------------------- ------------------

Period for which guarantees will be in force ---------------------

11. Arrangements for breeding of animals : (Indicate the type of bull kept, etc. if A.I. Centre not nearby) 12. Arrangements made for purchase of milch cattle feed, etc. ----------------------------------------------------------------------------Milch Cattle : Fodder Feed : : : Name of Agency Address ------------------------ ---------------

13. Arrangements for technical advice

(a) Details of technical staff employed: (b) Their experience in the line (in years/capacity) 14. Arrangements for marketing (i) In case of large Dairy Farms : : :

(a) Position regarding demand and Supply : (b) Definite arrangements made for Marketing of milk : (c) Are they made for cash or credit If for credit, specify period of Credit : (d) Whether the scheme comes Under the Intensive Cattle Development Programme of the State Govt/in milk shed area of Govt. Milk Scheme

(ii) In case of Small Dairies (a) Are you a member of Cooperative Milk Society? If so, name and Registered address. (b) Milk Societys financial position Membership & their liabilities Share Capital Reserve Fund

: : : : : :

(iii) Whether Milk Society is willing to undertake repayment of loan out of sale proceeds of the Milk : (iv) Terms/Mode of repayment 15. General Financial Position (a) In case of non-agriculturists (In case of firm/company audited balance sheet, P&L A/c. together with annual report to be enclosed. In case of others, statement of Assets and liabilities togetherwith Income tax assessment certificate To be enclosed). Other business/occupation, if any Annual Income : : :

: :

(b) In case of Agriculturists who take up dairy as main enterprise : (i) Size of operational holdins : (ii)Tenurial status (iii)Principal crops grown (iv)Annual Gross and Net Income, if any. (v) Particulars of liability, if any : : : : Loan Amt. Purpose of outstanding Loan ---------------- -------------Security Terms of offered repayment ----------- --------------

Source

(vi) Particulars of family members : (a) Total number of family members

Adults --------------------

Dependents ---------------------

(b) Particulars of adult members of the family : Name Age Relation Occupation

16.

Other particulars, if any :

I/We hereby confirm and declare that the information as given above is true to the best of my/our knowledge. If the loan applied for is sanctioned to me/us, I/We hereby undertake to abide by all the terms and conditions that may be stipulated for granting the loan.

Signature of Applicant(s) Place : Date : List of certificates to be enclosed by agriculturists

Extract of land revenue records for last three years

No dues certificate from the co-operative society to be obtained after the loan is sanctioned but before the amount is distributed. Applicable for 15(b).