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    ApplicationForm - MH 011 251639 07169311

    Uploaded by

    komalkadam1224

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    © All Rights Reserved
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    ApplicationForm - MH 011 251639 07169311

    Uploaded by

    komalkadam1224
    8 views4 pages

    Original Title

    ApplicationForm_MH-011-251639-07169311

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
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    8 views4 pages

    ApplicationForm - MH 011 251639 07169311

    Uploaded by

    komalkadam1224

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    PM Vishwakarma

    (Registration Form)

    Personal Details
    Full Name Father/Spouse Name Date Of Birth
    Ganesh Ram Dhongade S/O Ram Babu Dhongade 21-08-1988

    Marital Status Gender Category


    Married Male SC

    Divyangjan Business in same state?


    No Yes

    Business in same district? Minority?


    Yes No

    Contact Details
    Mobile No. Aadhaar No. PAN Card
    9623269680 XXXXXXXX4259 N.A.

    Family Details
    Ration Card No.
    272003241919

    Name Relationship Aadhaar No.


    RAMBABUDHONGADE HUSBAND xxxxxxxxxxxx
    ANITARAMDHONGADE SELF xxxxxxxxxxxx
    GANESHRAMDHONGADE SON xxxxxxxxxxxx
    MARUTIRAMDHONGADE SON xxxxxxxxxxxx
    Aadhaar Address
    Aadhaar Address
    C/o: S/O Ram Babu Dhongade House: sathe nagar Loc: nadives,miraj vtc: Miraj Subdist: Miraj Street: mhaishal road State: Maharashtra po: Miraj pc: 416410
    dist: Sangli Country: India

    State District Pin code


    MAHARASHTRA Sangli 416410

    Do you Come under Gram Panchayat? Name of ULB


    No Sangli-Miraj Kupwad

    Current Address
    Current Address
    C/o: S/O Ram Babu Dhongade House: sathe nagar Loc: nadives,miraj vtc: Miraj Subdist: Miraj Street: mhaishal road State: Maharashtra po: Miraj pc: 416410
    dist: Sangli Country: India

    State District Pin code


    MAHARASHTRA Sangli 416410

    Do you Come under Gram Panchayat? Name of ULB


    No N.A.

    Profession/ Trade Details


    Profession / Trade Name
    Sub Category
    Masons (Rajmistri)

    Business Address
    C/o: S/O Ram Babu Dhongade House: sathe nagar Loc: nadives,miraj vtc: Miraj Subdist: Miraj Street: mhaishal road State: Maharashtra po: Miraj pc: 416410
    dist: Sangli Country: India

    Business State Business District


    MAHARASHTRA Sangli
    Saving Bank Details
    Name of Bank IFSC Code Name of Branch
    Bank of Baroda BARB0MIRAJX MIRAJ BRANCH

    Account No. Confirm Account No.


    XXXXXXXXXXXXXX8166 04400100008166

    Credit Support
    Do you want Credit Support? Loan Amount Required (1st Tranche) Preferred Bank to Take Loan
    Yes 100000 Bank of Baroda

    Preferred Branch to Take Loan Loan Purpose Purchase of Equipments


    MIRAJ BRANCH Yes No

    Working Capital / Operating Expanses Business Expansion Outstanding Amount (in Rs.)
    Yes Yes N.A.

    Existing Loan Monthly EMI Amount (in Rs.) Total Monthly Family Income (in Rs.)
    N.A. N.A. N.A.

    Digital Incentive Details


    Are you Digitally Active? UPI ID UPI ID Linked Mobile Number
    No N.A. N.A.

    Skill Training
    You are eligible for skill training for below training programes.
    Basic (5 Days) Skill Training
    Advance (15 Days) Skill Training

    Tool Kit
    Once you are registered and skill training certified you will be given a grant of ₹15,000
    Marketing Support
    Marketing Support question that applies to your business expansion

    Declaration Details
    Declaration and Authorization
    1. I hereby declare that I am engaged in the trade as indicated in the application form.
    2. I hereby declare that apart from myself, no other member of my family has registered for PM Vishwakarma and that no member
    of my family is in government service.
    3. I have no objection to authenticate my Aadhaar number, share the same with other Ministries / Departments under the
    Government of India or the State Government for the purpose of extension of benefits under any of their Schemes, carry out e-KYC
    and accessing my credit history & credit score from credit bureau by the lenders and their authorized agents. The consent and
    purpose of collecting Aadhaar has been explained to me in local language. MoMSME/Lending Institution has informed me that my
    Aadhaar submitted herewith shall not be used for any purpose other than mentioned above, or as per requirements of law. I have
    been informed that this consent and my Aadhaar will be stored along with my account details with MoMSME or their authorised
    agent as per the extant law.
    4. I hereby agree that my application may also be processed for availing Udyam Assist Certification which will enable me for Priority
    Sector Lending (PSL) benefits.
    5. I hereby declare that information given above is true to the best of my knowledge. I am well aware of the fact that, if the
    information given by me is proved false/not true, I will be liable for action as per the law. Also, all benefits shall be summarily
    withdrawn.

    Date : 06/01/2024 Signature of Applicant(s)


    Place : Sangli

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