SHG and Member Profile Collection Form

State*: District*: Block*: GP*: Village*:

SHG Name*: Date of Formation*:

SHG Type* : □New □Pre-NRLM □Revived Date of Cooption/Revival into NRLM*:

Promoted By: NRLM/ State Project/ NGO/ Any Other
Bank: Branch Name: SB A/c Number: Date of Account Opening:

Meeting Frequency*: Monthly Amount of Saving per

Basic Training Received: Yes/No Active Bank Loan A/C Number:
Weekly/Fortnightly/Monthly member*:
Amount of Capital Subsidy/Grant *Name of Book Keeper :
*Have Trained Bookkeeper: No/Internal/External
received prior to NRLM: (if not No)

II. SHG MEMBER DETAILS

SN Member Name* Father/Husband Name* Social DOB* Sub Category PIP Leader* *Date of Education
Category (DD/MM/YYY category (L1- joining in SHG Level
* Y) Disability* Religion1* Gender (POP / Poor Presdent/
(No/Self / (Hindu/ Muslim/ * / Non-Poor) L2-Secy/L3-
(SC/
Christian/ Sikh/ (Male/ Tres/
ST/OBC/ Family Buddhist/ Jainism/
Female/ Member)
Other) Member) Parsi/Other)
Trans)

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 SN Member Name* Father/Husband Name* Social DOB* Sub Category PIP Leader* *Date of Education
Category (DD/MM/YY category (L1- joining in SHG Level
* YY) Disability* Religion1* Gender (POP / Poor Presdent/
/ Non-Poor) L2-Secy/L3-
(No/Self / (Hindu/ Muslim/ *
(SC/ Christian/ Sikh/ (Male/ Tres/Membe
Family Buddhist/ Jainism/
Female/ r)
ST/OBC/ Member) Parsi/Other)
Trans)
Other)

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1.H: Hindu, M: Muslim, C: Christian, S: Sikh, B: Buddhist, J:Jain, P: Parsi, O: Other

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State*: District*: Block*: GP*: Village*:

SHG Name*: Date of Formation*:

Bank: Branch Name: SB A/c Number:

Active Loan A/C Number:

SN Member Name* Enrolled in Insurance Aadhar Number Mobile No. Bank Branch SB Account Aadhar Signature/
Seeded Thumb
Number SB A/C
PMJJY PMSBY Others APY (Y/N)

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SN Member Name* Enrolled in Insurance Aadhar Number Mobile Bank Branch SB Account Aadhar Signature/
Seeded Thumb
No. Number SB A/C
PMJJY PMSBY Others APY (Y/N)

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Prepared By

Name: Signature: Date: Signature of Branch Manager