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ApplicationForm_UP-016-249513-32107478

The document is a registration form for PM Vishwakarma, detailing personal, contact, family, and business information of the applicant, Manthan Kumar Madhesia. It includes declarations regarding the authenticity of the provided information and consent for Aadhaar authentication. The applicant is engaged in the washerman trade and is not seeking credit support or digital incentives.

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18 views4 pages

ApplicationForm_UP-016-249513-32107478

The document is a registration form for PM Vishwakarma, detailing personal, contact, family, and business information of the applicant, Manthan Kumar Madhesia. It includes declarations regarding the authenticity of the provided information and consent for Aadhaar authentication. The applicant is engaged in the washerman trade and is not seeking credit support or digital incentives.

Uploaded by

akg852873
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

Manthan Kumar Madhesia S/O Ramji Prasad Madhesia 12-05-1998

Marital Status Gender Category

Unmarried Male OBC

Divyangjan Business in same state?

No No

Business in same district? Minority?

No No

Contact Details

Mobile No. Aadhaar No. PAN Card

8707048001 XXXXXXXX6974 N.A.

Family Details

Ration Card No.

N.A.

Name Relationship Aadhaar No.


MANSI MADHESHIYA OTHER xxxxxxxx4710
Aadhaar Address

Aadhaar Address

C/o: S/O Ramji Prasad Madhesia House: 17 Loc: Bahadurganj vtc: Ghazipur Subdist: Jakhanian Street: 5 State: Uttar Pradesh po: Bahadurganj pc: 275201 dist: Ghazipur
Country: India

State District Pin code

UTTAR PRADESH Ghazipur 275201

Do you Come under Gram Panchayat? Name of ULB/Zone

No Bahadurganj

Current Address

Current Address

C/o: S/O Ramji Prasad Madhesia House: 17 Loc: Bahadurganj vtc: Ghazipur Subdist: Jakhanian Street: 5 State: Uttar Pradesh po: Bahadurganj pc: 275201 dist: Ghazipur
Country: India

State District Pin code

UTTAR PRADESH Ghazipur 275201

Do you Come under Gram Panchayat? Name of ULB/Zone

No N.A.

Profession/ Trade Details

Profession / Trade Name


Sub Category
Washerman (Dhobi)

Business Address

C/o: S/O Ramji Prasad Madhesia House: 17 Loc: Bahadurganj vtc: Ghazipur Subdist: Jakhanian Street: 5 State: Uttar Pradesh po: Bahadurganj pc: 275201 dist: Ghazipur
Country: India

Business State Business District

UTTAR PRADESH Ghazipur

Saving Bank Details

Name of Bank IFSC Code Name of Branch

UNION BANK OF INDIA UBIN0534722 BAHADURGANJ

Account No. Confirm Account No.

XXXXXXXXXXXXXX4161 347202010934161
Credit Support

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

No 0 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

Onboard your product/ service on E- Commerce platform

Quality Certification Required

Participate in Exhibitions and Trade Fairs

Logistics support Required

Brand Building Support Required


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 : 17/03/2025 Signature of Applicant(s)


Place : Ghazipur

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