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APPENDIX-lll

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF AGRICULTURE
Application Form for Purchase of Agricultural Equipment/ Machinery
Space
For
Photograph
Part A
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Name of the Farmer/farmers:_________________________________________

Fathers / Husband s Name:_____________________________________________________________
KCC No.: ____________________________________________________________________________
Bank :_____________________________________Branch :__________________________________
Name of Organization (if applicable, give details):
Address: (a) Village:_______________________________________________________________________
(b) G.P:_____________________________________(c)Block:____________________________________
(d) PS :_____________________________________(e) Subdivision : ______________________________
(f) P.O. :____________________________________(g) District :__________________________________
(h) Phone /Mobile No. _____________________________________________________________________
Category of Farmer :
General / S.C. / S.T.
Area of Land Holding (in ha) :
Crops taken up during last year
Crop
Area
Irriggate:
Rainted :
Details of Agricultural Equipment / Machinery to be purchase ___
a)
Name of the item with Brand /Make & model :____________________________________________
b)
Name of Manufacturer : _____________________________________________________________
c)
Name of Authorized Supplier :________________________________________________________
Name of financing institution (in case of loan) : ________________________________________________

Signature of the farmer with

Address
Identified by----