GOVERNMENT OF GOA
DIRECTORATE OF ANIMAL HUSBANDRY AND VETERINARY SERVICES, PASHU
SANVARDHAN BHAVAN, PATTO PANAJI – GOA.
APPLICATION FOR SETTING UP PIGGERY UNIT CONSISTING OF 20 SOWS AND 2
BOARS WITH 25% SUBSIDY FROM STATE
1. Name of the applicant in :- ………………………………………………
Block Letters :………..………………………………………
2. Father’s Name / HusbandS/ : -…………………………………………..
if married
3. Permanent Address : -………………………………………………
a) Present Address :-…………………………..
b) House No :-…………………………..
c) Ward / Locality :-…………………………..
d) Village / Town :-…………………………..
e) Taluka :-…………………………..
f) District :-…………………………..
g) Telephone No. :-…………………………..
4. Whether Employed / Unemployed :-…………………………………………
Profession and Occupation if any …………………………………………
5. Date of Birth / Age :-…………………………..
6. Educational Qualification :-…………………………..
7. Whether the unit shall be set up ……………………………………….
with own finance or through Assistance ……………………………..
from the Bank , if from Bank /……………………………………………
Name of the Bank / Financing Institutions ………………………………….
from whom loan will be required: - ……………………………………
8. N.O.C. from Village Panchayat/:- ……………………………………………
(copy to be enclosed)
9. Whether the applicant or any :-…………………………………………….
Member of his / her family have …………………………………………….
availed subsidy from this
Department for setting up of
Piggery Unit or any other Animal
Husbandry Schemes earlier if so,
details may be indicated : -………………………………………………..
10. Whether having any Piggery unit at present and
if so, type and number to indicated: - ………………………………………
11. Whether the applicant has own land
for construction of the unit if yes,
Form I & XIV may be produced.
In case of Lease such a deed copy
may be enclosed:-………………………………………..
12. Whether you are willing to execute
a bond as per terms and conditions
of this Department for payment of subsidy: - ………………………………
DECLARATION
a) I, hereby declare that the above information given by me is true to the best of my knowledge and belief.
b) I also assure you that I shall utilized fully, the Department’s subsidy and loan sanctioned to me, for creating the intended asset, to enable me to carry on my profession / trade, failing which I solemnly agree that I shall be liable to refund the subsidy / bank loan forthwith. Further I authorize the Department of AH&VS, Government of Goa to initiate any legal procedures on me for default in case, I failed to utilize the funds sanctioned for Piggery Development for any other purpose.
Signature of the applicant
(NAME IN FULL)
Place: -
Date: -
13. Remarks / Recommendations
of Department’s area Veterinary
Officer with stamp and date.
Certifying date of inspection of site,
Verification of required documents etc.
14. Final utilization Certificate from
concerned Veterinary Officer of the
Department. All bills, Health certificates,
Valuation etc to be countersigned / certified.