Interview cum Appraisal form
For Finance to Agri Clinic/Agri Business

ANNEXURE

Name of the Applicant _____________________

1. Qualification and experience
(enclose copy of degree certificate in agri)

2. What is the present occupation of applicant.

3. What is the reputation and network of applicant to make agri clinic/agri business a success.

4. What is the value addition he can give to his customers on other Government Agencies.

5. Loan amount required for
Purchase of equipment such as computer, broad band of internet connection of business space, telephone, employees, license to calling business etc. (give detailed cost data)
Others (specify)

Total amount required for activity
Investment from own sources (margin)
Net amount of loan required.

6. Economics in Rs.
(i) Total expenditure 1st year 2nd year 3rd year
a. For fixed assets
b. For working capital

(ii)
Gross returns expected
(iii) Net Profit

7. Terms of repayment proposed

Signature of Appraising Officer Signature of Applicant/s