GOVERNMENT OF GOA
DEPARTMENT OF ANIMAL HUSBANDRY & VETERINARY
SERVICES, PASHU SANVARDHAN BHAVAN, PATTO- PANAJI- GOA
(SPECIAL CALF REARING SCHEME)
APPLICATION FORM
(One form is to be utilized per calf)
1) Name of the beneficiary -----------------------------------------
2) Address-----------------------------------------------------------
3) Tel. No. or Contact Tel. No.--------------------------------------
4) Educational Qualification:----------------------------------------
5) Profession:--------------------------------------------------------
6) Ration Card No:--------------------------------------------------
(Copy to be enclosed having beneficiary)
7) whether benefit of scheme was availed earlier (YES/NO)
(If yes, Give details below)
8) Identification Mark -------------- Tag No. --------- Age -------
a.
b.
c.
d.
9) Date of Birth of Calf ----------------------------------------------
(for which feed assistance is applied)
1) Identification Mark ---------------------------------------------
2) Whether farmer has facility to rear calf ------------------------
3) Previous experience in the field --------------------------------
4) Present weight of calf and age ----------------------------------
5) Registration number ---------------------------------------------
6) Whether member of Dairy Co-operative Society. Yes/No
7) If yes, Name of the Dairy Society.
8) I solemnly state and affirm that I will not take feed under any other Govt. Scheme or from any other organization/Institution for this particular calf.
Signature of
Applicant
I consider that the case is feasible and the beneficiary has the desire to rear the animal as per recommendation of the Department. Further, I verify that the Calf is not getting feed from any other scheme of the Govt/ other Institution.
Signature of E.O.
I agree to all the points in the application and to the remarks of
E.O. (AH)
Signature of V.O.
Dated:-