Application for registration of Poultry Farm / Unit with the
Department of Animal Husbandry & Veterinary Services
Panaji- Goa.
For the purpose of claiming of Subsidy for Transportation of feed
1) Name of Poultry Farmer:-----------------------------------------------
2) Name of Father/ Husband (if married):-------------------------------
3) Full postal Address:----------------------------------------------------
House No.Ward
VillageTown
Taluka
4) Tel. No. ------------- 1) Residence ---------------- 2) Mobile if any.
5) Year of establishment of farm:-
6) Name of farm:----------------------------------------------------------
7) Address of farmer:-----------------------------------------------------
Name of place Ward
VillageTown
8) Type of Poultry Farm 1) Broilers------------ 2) Layers-----------
9) Capacity of farm: ------------------------------.
10) Present stock of birds
11) Whether subsidy availed from Department to start the farm
Yes/No
If yes detail of subsidy Amount in total
12) Quantity of feed Required at present and type of feed:
13) Quantity of feed purchased per month: ----------------------------
14) Source of purchase of feed with name and address of the seller:
15) Whether a feed register is opened and maintained by the
farmer at present, if not agree to maintain same immediately.
16) Any Additional Information:-
Place: Name &
Signature
of farmer with
date
Date:
17) I hereby certify that the information given by the applicant is Verified by me and is correct to best of my knowledge.
Signature of V.O./
Asstt. Director
With date &
Office stamp.
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