Annexure -2
Recommendation for fund release from DMMU to BLF.
S.
Particulars Details
No.
1 Name of the Block
2 Name of the Cluster/Activity
3 Name of the Panchayat
Grama Sabha approval date of selected
4
Beneficiary
5 Date of Account opening
6 Bank Name
7 Branch Name and IFSC code
8 Account Name as per bank passbook
9 Account Number
10 Secretary Name and Mobile Number
11 Treasurer name and Mobile Number
Beneficiary eligibility (Sub format
12 enclosed) for number of Beneficiaries
whether verified
13 Per member contribution in (Rs.)
14 Conduct of Regular meeting
15 Name of the Register Maintained
Near by market (mentioned name and
16
distance)
Cluster formation and selection of beneficiaries are verified as per
guidelines and recommended for release of funds to the ____________cluster of
____________PLF in _____________Block through BLF.
Block Coordinator Block Mission Manager Asst. Project Officer
(LH) (LH)
Annexure -3
Sub Format for Eligibility of Beneficiary Identified***
S. No. Particulars Details
1 Name of the Beneficiary
2 Name of the Husband/ Guardian
3 Address
4 Date of Birth/Age
5 Mobile Number
6 Name of the SHG
7 Number of years as an SHG member
8 NRLM member ID No.
9 Community(SC/ST/MBC/BC/Others)
10 Whether comes under special category
(Diff. abled / Widows/Destitute widows)
11 Aadhar card Number
12 Smart card Number
13 Do you have MGNREGA card?,If yes
provide card number
14 PIP Number and Category
15 Total area of Land owned /
leased(Acres)
16 Whether the member presently rearing
backyard poultry?
17 Experience in backyard poultry rearing
18 Area of land proposed for rearing
backyard poultry (in cents)
19 Any loan availed under livelihood
activities
a. Name of the scheme:
b. Loan amount availed in Rs.
20 Any overdue / NPA in Rs.
I declared that the above details are correct and in line with my consensus.
Date : Beneficiary Signature
Place:
The above details were verified by me and found correct
Name of the CRP(Farm):
CRP(Farm) Mobile Number:
Signature of CRP(Farm):
Attachment:
1. Aadhar Card Xerox Copy
2. Smart Card Xerox Copy
3. MGNREGA Xerox card
4. SHG Resolution copy for the number of years as an SHG member
5. SHG Resolution copy not tobe a office bearer in BLF/PLF
6. SHG Resolution copy for No overdue or NPA in any Bank/institution
7. Patta copy/Lease agreement copy
8. Selected Member Grama saba approval copy
*** This format to be collected for each beneficiary separately and attached to the Annexure-1 for fund
release to BLF.