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PM Vishwakarma: (Registration Form)

The document contains a registration form for Priya Biswas, an unmarried female tailor from Nadia, West Bengal, which includes her personal, family, and business contact details as well as information about her eligibility for skill training, a tool kit grant, and marketing support through the PM Vishwakarma program. The form also includes declarations authorizing the sharing of her Aadhaar information and certifying that the provided information is true.

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prasenjitmandal3842
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2K views4 pages

PM Vishwakarma: (Registration Form)

The document contains a registration form for Priya Biswas, an unmarried female tailor from Nadia, West Bengal, which includes her personal, family, and business contact details as well as information about her eligibility for skill training, a tool kit grant, and marketing support through the PM Vishwakarma program. The form also includes declarations authorizing the sharing of her Aadhaar information and certifying that the provided information is true.

Uploaded by

prasenjitmandal3842
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PM Vishwakarma

(Registration Form)

Personal Details
Full Name Father/Spouse Name Date Of Birth
PRIYA BISWAS 15-03-2001

Marital Status Gender Category


Unmarried Female SC

Divyangjan Business in same state?


No Yes

Business in same district? Minority?


Yes No

Contact Details
Mobile No. Aadhaar No. PAN Card
8016772394 XXXXXXXX4275 FSJPB8841J

Family Details
Ration Card No.
1903171480

Name Relationship Aadhaar No.


PRANAB BISWAS OTHER xxxxxxxxxxxx
MUKTI BISWAS WIFE xxxxxxxxxxxx
PRIYA BISWAS DAUGHTER xxxxxxxxxxxx
PRITISH BISWAS SON xxxxxxxxxxxx
Aadhaar Address
Aadhaar Address
vtc: BagulaStreet: DURGAPURState: West Bengalpc: 741502dist: NadiaCountry: India

State District Pin code


WEST BENGAL Nadia 741502

Do you Come under Gram Panchayat?


Yes

Block Gram Panchayat


HANSKHALI BAGULA-I

Current Address
Current Address
vtc: BagulaStreet: DURGAPURState: West Bengalpc: 741502dist: NadiaCountry: India

State District Pin code


WEST BENGAL Nadia 741502

Do you Come under Gram Panchayat?


Yes

Block Gram Panchayat


N.A. N.A.

Profession/ Trade Details


Profession / Trade Name
Sub Category
Tailor (Darzi)

Business Address
vtc: BagulaStreet: DURGAPURState: West Bengalpc: 741502dist: NadiaCountry: India

Business State Business District


WEST BENGAL Nadia

Saving Bank Details


Name of Bank IFSC Code Name of Branch
State Bank of India SBIN0001302 BAGULA

Account No. Confirm Account No.


XXXXXXXXXXXXXX7144 XXXXXXXXXXXXXX7144
Credit Support
Do you want Credit Support? Loan Amount Required (1st Tranche) Preferred Bank to Take Loan
Yes 100000 N.A.

Preferred Branch to Take Loan Loan Purpose Purchase of Equipments


N.A. No No

Working Capital / Operating Expanses Business Expansion Outstanding Amount (in Rs.)
No No 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 : 10/11/2023 Signature of Applicant(s)


Place : Nadia

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